Coronary Heart Disease Diagnosis
Screening for coronary heart disease
Heart disease can be a silent condition, meaning you may not have any symptoms until you have a serious health problem, such as a heart attack. Having regular check-ups is important to help your doctor know your risk and recommend healthy lifestyle changes to prevent heart disease.
You should start getting screening tests and risk assessments for coronary heart disease around age 20 if you do not have any risk factors for it. Children may need screening if they have risk factors, such as obesity, low levels of physical activity, or a family history of heart problems.
Your doctor may recommend preventive treatments such as heart-healthy lifestyle changes to help you lower your risk of coronary heart disease.
To screen for coronary heart disease, your doctor will:
- Assess risk factors to help evaluate your risk of developing coronary heart disease
- Check blood pressure readings to see whether you have high blood pressure
- Calculate your body mass index and waist circumference to see whether you have an unhealthy weight
- Order blood tests to see whether you have high blood cholesterol, high blood triglycerides, or diabetes
Screening usually happens in a provider's office, but sometimes screenings are done at health fairs, drugstores, or other places. Blood samples might be collected at the provider’s office, a hospital, or a laboratory.
Ask whether you need to fast (not eat or drink anything besides water) before the blood tests.
Diagnostic tests and procedures
If you have symptoms of coronary heart disease, your healthcare provider may order tests to see if you have coronary heart disease. Your provider will also likely order blood tests to check the levels of cholesterol, triglycerides, sugar, , or proteins that are a sign of inflammation.
- An electrocardiogram (EKG or ECG) determines whether the heart’s rhythm is steady or irregular. An EKG also records the strength and timing of electrical signals as they pass through the heart.
- A coronary calcium scan measures the amount of calcium in the walls of your coronary arteries. This test is a type of cardiac CT scan. Coronary calcium scans can also help assess coronary heart disease risk for people who smoke or for people who do not have heart symptoms.
- Stress tests check how your heart works during physical stress. During stress testing, you walk or run on a treadmill or pedal a stationary bike to make your heart work hard and beat fast. If you have a medical problem that prevents you from exercising, your doctor may give you medicine to make your heart work hard, as it would during exercise. To detect reduced blood flow to your heart muscle, while you exercise you will be monitored by ECG and possibly echocardiogram or CT scan.
- Cardiac MRI (magnetic resonance imaging) detects tissue damage or problems with blood flow in the heart or coronary arteries. It can help your doctor diagnose coronary microvascular disease as well as nonobstructive or obstructive coronary artery disease. Cardiac MRI can also help explain results from other imaging tests.
- Cardiac positron emission tomography (PET) scanning assesses blood flow through the small coronary blood vessels and into the heart tissues. This is a type of nuclear heart scan that can diagnose coronary microvascular disease.
- Coronary angiography shows the insides of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. This procedure is often used if other tests show that you are likely to have coronary artery disease. To diagnose coronary microvascular disease, your doctor will use coronary angiography with guidewire technology to help navigate to the smaller spaces.
- Coronary computed tomographic angiography is a non-invasive imaging test using CT scanning to show the insides of your coronary arteries rather than an invasive cardiac catheterization.
Your provider may use a risk calculator to estimate your risk of having a heart attack, having a stroke, or dying from heart or blood vessel disease in the next 10 years or throughout your lifetime.
For example, the Atherosclerotic Cardiovascular Disease (ASCVD) Estimator considers your levels, age, sex, race, and blood pressure. It also factors in whether you smoke or take medicines to manage your high blood pressure or cholesterol.
Ask about your risk during your annual check-up. Knowing your risk will help you and your provider decide on healthy lifestyle changes and possibly medicines to lower your risk.
Risk assessments should be repeated every 4 to 6 years in adults 20 to 79 years of age who do not have heart or blood vessel disease.
No single risk calculator is appropriate for all people. Calculators can give you and your doctor a good idea about your risk, but your provider may consider other factors to estimate your risk more accurately.
Commonly used risk calculators might not accurately estimate risk in certain situations.
- Risk calculators may not account for complications during pregnancy or had early menopause.
- People with metabolic syndrome or an inflammatory or autoimmune condition also need to be aware that common risk calculators may not factor in their condition.
- Family history of heart or blood vessel disease at a young age may also cause an inaccurate estimate.
- People who use statins to manage cholesterol levels will also get an inaccurate estimate of risk from these calculators.
In these cases, your healthcare provider may suggest other tests for coronary heart disease even if the ASCVD Risk Estimator or other calculator says you are not at high risk.