Angina (Chest Pain) Diagnosis

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Your healthcare provider may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. Tests can rule out other conditions and help determine whether you need medical attention right away.

Typically, healthcare providers ask about angina pain only when you have symptoms that you report during an office visit. Every few years, your provider may estimate your chances of having heart disease as part of your regular office visits.

Your healthcare provider will want to learn about your symptoms and risk factors, such as your personal and family health history, to determine whether your chest discomfort is due to angina or other causes. Be sure to mention any heart disease risk factors and other medical conditions you might have, including diabetes or kidney disease. Even if your chest pain is not angina, it can still be a symptom of a serious medical problem with your heart, blood vessels, chest muscles, lungs, or digestive system.

Tell your provider if you notice a pattern with your symptoms. Ask yourself these questions:

• What does the pain or discomfort feel like?
• Where do you feel it?
• How long does it last?
• How often does it occur?
• How intense is it?
• What brings it on, and what makes it better?

As part of a physical exam, your healthcare provider may measure your blood pressure and heart rate, feel your chest and belly, take your temperature, listen to your heart and lungs, and check your pulse.

Depending on your symptoms and risk factors, your healthcare provider may want to run some tests to check for medical emergencies.

• An electrocardiogram (ECG) can help recognize types of angina and other serious heart problems. Certain ECG patterns can be a sign of unstable angina or vasospastic angina. However, your ECG may sometimes be normal even if you have angina.
• A chest X-ray is useful in screening for lung disorders and other causes of chest pain, such as pneumonia and heart failure. A chest X-ray alone is not enough to diagnose angina or coronary heart disease, but it can help rule out other causes of your symptoms.
• Blood tests can measure the level of cardiac troponin in your blood to help healthcare providers tell unstable angina from a heart attack. Troponin is a type of protein found in the heart muscles. When the heart muscles are damaged, troponin can leak into the bloodstream. Your provider may also check levels of other proteins, certain fats, cholesterol, and sugar in your blood.

To check how well your heart works, your provider may have you undergo some of the following heart tests as well.

• An echocardiogram, or echo, can show how well your heart pumps blood to the rest of your body. An echo may help identify problems inside your heart, such as blood clots or damaged heart valves.
• Cardiac magnetic resonance imaging (MRI) and other noninvasive tests can help check for problems with your heart’s movement or blood supply.
• Stress testing checks how well your heart works during exercise. A stress test can help confirm whether coronary heart disease is causing your angina symptoms.
• Coronary computed tomography (CT) angiography looks at blood flow through your coronary arteries. This test can help confirm whether you have coronary heart disease.
• Invasive coronary angiography allows healthcare providers to study blood flow through your heart and coronary arteries closely. This test can help accurately identify coronary heart disease and determine whether surgery or other procedures might relieve your angina symptoms.
• A provocation test can help diagnose vasospastic and microvascular angina. Your provider may use this test during invasive coronary angiography to see whether a chemical that causes angina symptoms can cause your coronary arteries to spasm.