Angina (Chest Pain) Diagnosis

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Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.

Your doctor will want to learn about your symptoms, risk factors, personal health history, and family health history to determine whether your chest pain is angina or is caused by something else. Other heart and blood vessel problems or problems with your chest muscles, lungs, or digestive system can cause chest pain.

Tell your doctor if you notice a pattern to your symptoms. Ask yourself these questions:

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

Your doctor will also need information about heart disease risk factors and other medical conditions you might have, including diabetes and kidney disease. Even if your chest pain is not angina, it can still be a symptom of a serious medical problem. Your doctor can recommend steps you need to take to get medical care.

As part of a physical examination, your doctor will measure your blood pressure and heart rate, feel your chest and belly, take your temperature, listen to your heart and lungs, and feel your pulse.

Your doctor may have you undergo some of the following tests and procedures.

• Blood tests check the level of cardiac troponins. Troponin levels can help doctors tell unstable angina from heart attacks. Your doctor may also check levels of certain fats, cholesterol, sugar, and proteins in your blood.
• Chest X-ray looks for lung disorders and other causes of chest pain not related to heart disease. A chest X-ray alone is not enough to diagnose angina or heart disease, but it can help rule out other causes.
• Computed tomography angiography looks at blood flow through the coronary arteries. This test can rapidly diagnose heart disease as the source of your chest pain and help your doctor decide whether a procedure to improve blood flow will benefit your future health.
• Coronary angiography with cardiac catheterization can help determine whether coronary heart disease is the cause of your chest pain. This test lets your doctor study the flow of blood through your heart and blood vessels to confirm whether plaque buildup is the problem. The results of the scan can also help your doctor assess whether unstable angina might be relieved by surgery or other procedures.
• Echocardiogram assesses the strength of your heart beating, to help the doctor determine your risk of future heart problems.
• Electrocardiogram (EKG) checks for the possibility of a heart attack. Certain EKG patterns are associated with variant angina and unstable angina. These patterns may indicate serious heart disease or prior heart damage as a cause of angina. However, some people who have angina have normal EKGs.
• Hyperventilation testing can help diagnose variant angina. Rapid breathing under controlled conditions with careful medical monitoring may bring on EKG changes that help your doctor diagnose variant angina.
• Magnetic resonance imaging or other noninvasive tests checks for problems with the heart’s movement or with blood flow in the heart’s small blood vessels.
• Provocation tests can help diagnose variant angina. Your doctor may give you a medicine such as acetylcholine during coronary angiography to see if the coronary arteries start to spasm.
• Stress testing assesses how well your heart works during exercise. A stress test can show possible symptoms of coronary heart disease causing your angina. Stress testing in the early morning can help diagnose variant angina. Stress echocardiography tests can help your doctor diagnose the cause of your angina.

Typically, doctors screen for angina only when you have symptoms. However, your doctor may assess your risk factors for heart disease every few years as part of your regular office visits. If you have two or more risk factors, then your doctor may estimate the chance that you will develop coronary heart disease, which may include angina, over the next 10 years.