Coronary Artery Disease Diagnosis

A diagnosis of coronary artery disease is based on a person's risk factor assessment, physical examination, laboratory tests, and other medical tests.

Risk factor assessment

A coronary artery disease risk factor assessment is based on person's medical history and the medical history of their family members. A doctor or other healthcare provider gathers information by asking specific questions. A questionnaire is often used to help organize the information.

• The medical history contains information about a person's:
  • Health (high blood pressure, diabetes, previously diagnosed heart disease condition, thyroid condition)
  • Lifestyle (physical activity, smoking, alcohol use)
  • Drug use (prescription and over-the-counter medications, supplements, herbs, illegal drugs)
• The family medical history contains information about health problems of family members.
  

Physical examination

The physical examination helps identify any coronary artery disease symptoms. In addition to measuring a person's blood pressure and pulse, the doctor:

• Listens to the chest for abnormal heart and lung sounds.
• Examines the person's eyes, arms and legs, and skin.

Laboratory tests

Laboratory tests are ordered based on a person's risk factor assessment and physical examination. The tests checks for test results that fall outside of the normal ranges. Laboratory tests for coronary artery disease may include:

• Blood chemistry test (includes serum sodium, potassium, chloride, carbon dioxide, and blood urea nitrogen)
• BNP (brain natriuretic peptide, which is a cardiac biomarker)
• Cardiac enzymes (checks creatine kinase, myoglobin, and troponin)
• Complete blood count
• C-reactive protein test (blood protein that is a sign of inflammation)
• Fasting glucose test (checks blood sugar level)
• Lipoprotein profile (checks cholesterol and triglyceride levels)
• Liver function test
• Thyroid hormone test
• Urinalysis

Medical tests

Additional medical tests help:

• Identify the presence of a person's coronary artery disease risk factors.
• Rule out other diseases.
• Identify the presence and severity of coronary artery disease.
• Determine a person's treatment options.

A person's risk factor assessment and physical exam determine which medical tests the doctor will order. Tests for coronary artery disease may include:

• Coronary angiography with cardiac catheterization
  Coronary angiography uses X-rays to examine the coronary arteries after a radiopaque substance is injected into a coronary artery using cardiac catheterization. Cardiac catheterization passes a thin, flexible tube through a coronary artery or into the heart's chambers.
• Echocardiogram
  An echocardiogram uses sound waves (ultrasound) to create moving images of the heart. The test identifies blood flow, heart contractions, and muscle damage.
• Electrocardiogram (ECG, EKG)
  An ECG measures the heartbeat's rate and regularity.
• Electron-beam computed tomography
  Computed tomography (CT, CAT) uses X-rays to produce cross-sectional computerized images of the body to identify possible medical conditions. Electron beam computed tomography is a type of CT developed to create better images of the heart structures which never stop moving.
• Magnetic resonance angiography (MRA)
  MRA uses magnetic fields and radio waves to produce images of the blood vessels in the heart. This test doesn't require cardiac catheterization.
• Nuclear heart scan
  A radioactive tracer is injected into a person's bloodstream, and then pictures are taken of the heart's blood flow.
• Stress test
  A stress test measures ECG and blood pressure while people exercise or after they take medication to make their hearts beat faster.