Atherosclerosis
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Atherosclerosis

Atherosclerosis Diagnosis

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To diagnose atherosclerosis, your doctor will check the results of blood tests, imaging procedures, and other tests and also ask about your medical and family history. A physical exam helps detect symptoms.

Screening tests

Beginning at age 20, your doctor will regularly check to see if you have risk factors for plaque buildup in the arteries. Your doctor may:

Estimating your risk

Talk with your healthcare provider about risk factors:

  • Lifestyle habits such as smoking or vaping, physical activity, and eating habits
  • Your personal health history of medical conditions that may affect your risk, including diabetes and inflammatory conditions, such as rheumatoid arthritis and psoriasis
  • Your family history if you have blood relatives who had heart attacks or died suddenly before they were 55 years old

A risk estimator app can help assess the risk that you’ll have a major complication, such as a heart attack, from atherosclerosis. The app estimates your risk over the next 10 years or throughout your lifetime based on your data. If you have all the information, you can use the app yourself. The app shows risk levels as low, borderline, intermediate, or high.

Diagnostic tests

To diagnose atherosclerosis, your doctor may order tests. Your doctor may recommend tests even if you do not have symptoms. The type of test depends on which arteries are affected by plaque buildup.

Blood tests

Blood tests check the levels of cholesterol, triglyceride, blood sugar, lipoproteins, or proteins that are signs of inflammation, such as C-reactive protein.

Electrocardiogram

An electrocardiogram, also called an ECG or EKG, is a simple, painless test that detects and records your heart’s electrical activity. An EKG can show how fast your heart is beating, whether the rhythm of your heartbeats is steady or irregular, and the strength and timing of the electrical impulses passing through each part of your heart. You may have an EKG as part of a routine exam to screen for heart disease.

An EKG may be recorded in a doctor’s office, an outpatient facility, in a hospital before major surgery, or as part of stress testing. For the test, you will lie still on a table. A nurse or technician will attach up to 12 electrodes to the skin on your chest, arms, and legs. Your skin may need to be shaved to help the electrodes stick. The electrodes are connected by wires to a machine that records your heart’s electrical activity on graph paper or on a computer. After the test, the electrodes will be removed.

An EKG has no serious risks. EKGs don’t give off electrical charges such as shocks. You may develop a slight rash where the electrodes were attached to your skin. This rash usually goes away on its own without treatment.

Heart imaging tests

Your doctor may order a heart imaging test to take pictures of your heart and find problems in blood flow in the heart or coronary arteries.

Examples of heart imaging tests used to diagnose atherosclerosis appear below.

  • Angiography is a special type of X-ray using a dye. This procedure can be used to check the arteries in the heart, neck, brain, or other areas of the body.
  • Cardiac MRI (magnetic resonance imaging) detects tissue damage or problems with blood flow in the heart or coronary arteries. Cardiac MRI can help explain results from other imaging tests such as chest X-rays and CT scans.
  • Cardiac positron emission tomography (PET) scanning assesses blood flow through the small blood vessels of the heart. This is a type of nuclear heart scan that can diagnose coronary microvascular disease.
  • Coronary computed tomographic (CT) angiography shows the insides of your coronary arteries rather than an invasive cardiac catheterization. It is a noninvasive imaging test using CT scanning.

Coronary calcium scan

A coronary calcium scan is a CT scan of your heart that measures the amount of calcium in the walls of your coronary arteries. Buildup of calcium, or calcifications, are a sign of atherosclerosis or coronary heart disease.

A coronary calcium scan may be done in a medical imaging facility or hospital. The test does not use contrast dye and will take about 10 to 15 minutes to complete. A coronary calcium scan uses a special scanner such as an electron beam CT or a multidetector CT (MDCT) machine. An MDCT machine is a much faster CT scanner that makes high-quality pictures of the beating heart. A coronary calcium scan will determine an Agatston score that reflects the amount of calcium found in your coronary arteries. A score of zero is normal. In general, the higher your score, the more likely you are to have heart disease. If your score is high, your doctor may recommend more tests.

A coronary calcium scan has few risks. There is a slight risk of cancer, particularly in people younger than 40 years old. However, the amount of radiation from one test is similar to the amount of radiation you are naturally exposed to over one year. Talk to your doctor and the technicians performing the test about whether you are or could be pregnant.

Stress tests

A stress test measures how healthy your heart is and how well it works during physical stress. Some heart problems are easier to identify when your heart is working hard to pump blood throughout your body, such as when you exercise.

You may do a stress test in your doctor’s office or a hospital. The test usually involves physical exercise such as walking on a treadmill or riding a stationary bicycle. If you are not able to exercise, your doctor will give you medicine that will make your heart work hard and beat faster, as if you were exercising. Your doctor may ask you not to take some of your prescription medicines or to avoid coffee, tea, or any drinks with caffeine on the day of your test, because these may affect your results. Your doctor will ask you to wear comfortable clothes and shoes for the test.

Ankle-brachial index (ABI) test

Ankle-brachial index (ABI) tests are used to diagnose peripheral artery disease. This painless test compares the blood pressures in your ankle and your arm using a blood pressure cuff and ultrasound device.

ankle-brachial index
The illustration shows the ankle-brachial index test. The test compares blood pressure in the ankle with blood pressure in the arm. As the blood pressure cuff deflates, the blood pressure in the arteries is recorded.
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