Tests used to diagnose and guide treatment of cardiovascular disease will be a core part of your journey as a cardiovascular patient. This is true whether you first receive tests
• to understand your risk for serious events such as a heart attack or stroke,
• to identify the cause of symptoms that are bothering you, or
• as part of emergency treatment.
Knowing what kinds of tests you may undergo and how those tests work can help reduce stress in a time when you may find yourself facing many new questions. The following tests can be used to diagnose your condition and provide expectations as you work with your care team to keep your cardiovascular system as healthy as possible.
An angiogram is a diagnostic procedure that provides detailed, x-ray pictures of your heart and its blood vessels. It is performed by a specially trained cardiologist, called an interventional cardiologist.
Ankle-Brachial Index (ABI)
A simple test, called the ankle-brachial index, or ABI, can quickly and painlessly determine if you likely have peripheral artery disease (PAD), which means blockages in the blood vessels leading to your legs. PAD, also referred to as peripheral vascular disease (PVD), can cause discomfort or weakness while walking and, if severe and left untreated, can potentially lead to amputation of the leg or foot.
Have you ever made an appointment with your physician only to find that once you are in the office the problem you’ve been having has gone away? Sometimes a “snapshot” of your heart’s health at the moment you are in the office or hospital is not enough to demonstrate your symptoms. Your cardiologist may need information about how your heart is performing over time to make a diagnosis.
Blood Pressure Test
High blood pressure (also called hypertension) is linked to an increased risk of heart disease, and other cardiovascular conditions. When a medical professional measures your blood pressure, that person is measuring the force with which blood moves through your artery walls. Too much force can damage the artery walls, leading to cardiovascular disease.
Cardiac Enzyme Test
A cardiac enzyme test is one means for assessing if a person is currently experiencing or recently had a heart attack. If you have come to the emergency department with chest pain, cardiac enzymes may be drawn two or three times, several hours apart. It can also be used to check the functioning of the heart after coronary artery bypass graft surgery or angioplasty.
A chest x-ray produces an image of the inside of the chest showing the bones, heart and blood vessels. Chest x-rays usually show the chest in two views: from the front and from the side. Although chest x-rays are not as sophisticated as some other diagnostic technologies, they provide information that cannot be obtained in an examination.
A blood cholesterol test gives your physician important information about your risk for cardiovascular disease and can also be used to see if medications prescribed to lower cholesterol levels are working. This blood test is used to measure total cholesterol levels, LDL (or “bad”) cholesterol, HDL (or “good”) cholesterol and triglycerides. When all types of blood fat are checked at the same time, it is called a lipoprotein profile.
Computerized Tomographic Angiography
Computerized tomographic angiography, also called CTA or CT angiography, uses x-rays and computers to create detailed images of the blood vessels and the blood flow within them. CTA can be performed to evaluate many of the body’s arterial systems, such as the heart, the brain, or the blood vessels coursing through the chest, abdomen and pelvis.
Coronary Calcium Score
A coronary calcium score is a test result that can give your physician information about your risk for heart disease. A coronary calcium scan is performed through a CT scan, which uses x-rays and a computer to create three-dimensional images of your coronary arteries – the arteries that supply the heart with blood. The CT scan detects calcium deposits in the arteries, which show up as white specks on the image.
C-Reactive Protein (CRP) Test
A high sensitivity C-reactive protein (HS-CRP) test measures levels of CRP in the bloodstream. CRP is a protein that is released when inflammation is present in the body. Inflammation of the arteries is a risk factor for cardiovascular disease, and CRP may be a predictor of risk for heart attack, stroke, or other cardiovascular problems. An elevated CRP may confer additional predictive value to your other cardiac risk factors.
Diabetes and Diagnosing Cardiovascular Disease
If you have diabetes, your primary care physician may already have talked with you about the importance of taking care of your heart and blood vessels. If not, you should bring up the topic and ask your doctor to evaluate how high your risk for cardiovascular disease is and what you should do to prevent a heart attack, stroke, or peripheral artery disease (PAD).
Diagnosing a Heart Attack
Heart attack diagnosis can take place beginning at any one of several points: in the ambulance on the way to the hospital, in a hospital’s emergency room, or at the hospital after a heart attack has already taken place. The medical professionals who treat you at any of these stages will use symptom evaluation and tests to diagnose a heart attack. Learn more about the tests that are commonly used to diagnose a heart attack.
Diagnosing a Stroke
How well you recover from a stroke has a lot to do with how quickly your stroke is diagnosed and treatment begins. Emergency personnel, physicians, and other members of the stroke care team at the hospital will perform and order tests to determine as quickly as possible if you are having a stroke, and if you are, the type of stroke and the location of the problem.
Diagnosing Coronary Artery Disease
To determine whether you have coronary artery disease, and how severe it is, your doctor will talk with you about your health, lifestyle, and family history. This information, plus the results of a physical examination and blood tests will help determine whether you have risk factors for heart disease.
Diagnosing Heart-Related Chest Pain (angina)
Even though chest pain is not always caused by the heart or lungs, doctors in the emergency department will first want to check these organs. Conditions affecting the heart and lungs can be life threatening and must be treated quickly. A doctor can perform a thorough exam and ask you about your symptoms and medical history. Then several tests can be done to find out if your chest pain involves your heart or lungs.
Diagnosing peripheral artery disease (PAD)
To diagnose peripheral artery disease - blockages in the arteries leading to your legs, feet, or arms - your physician may ask you about your medical history, if you have a history of heart disease in your family, and questions that can determine if your lifestyle increases your risk. He or she will also ask about your symptoms, such as pain or heaviness in your legs muscles during exercise. If your doctor suspects you have PAD, he or she will recommend tests to verify the diagnosis.
Diagnosis of a Heart Valve Condition
Your family doctor or internist may be the first to suspect that you have a heart valve condition. He or she may detect a heart murmur while listening to your heartbeat through a stethoscope. A heart murmur is an extra – or unusual – sound heard when the heart beats. A murmur can be faint or it can create a noticeable whooshing noise. Heart murmur is common – and most murmurs do not indicate a problem.
An echocardiogram - also called a Doppler, heart ultrasound or “echo,” - is a noninvasive test that uses sound waves to create a moving picture of the heart. Just as a baby in the mother’s uterus can be visualized with ultrasound, pictures of the heart can help doctors evaluate the heart’s structures, including the muscles and valves.
An electrocardiogram, also called an ECG or EKG, is a quick, painless test that measures the heart’s electrical activity and records any disturbances in heart rhythm. The heart’s electrical activity determines if it keeps a normal rhythm.
An event monitor, or recorder, is a wearable device that records the electrical activity of your heart periodically for up to a month. While a Holter monitor gathers data about the heart’s activity continuously, an event monitor records data only when an “event” is occurring - that is, when you are experiencing symptoms.
While all aspects of the medical field are constantly evolving, this is particularly true of genetic testing. Currently genetic tests are available and recommended for a limited number of medical conditions, though more tests become available each year.
A Holter monitor is a device that records your heart’s rate and rhythm, usually over a period of 24 to 48 hours. The monitor is a small, box-shaped electronic device that is connected with wires (leads) to sticky patches (electrodes) that are placed on the skin of your chest. The monitor is attached to a strap that goes around your shoulder or waist to hold it close to your body.
How Your Physician Chooses Tests
Your physician will draw upon both his or her experience and detailed professional guidelines to determine which tests to order or perform. Questions to Ask Your Doctor in this section can help you discuss testing with your physician.
Implantable Loop Recorder
An implantable loop recorder is a medical device that is placed beneath the skin in the chest to record data about heart events over a long period of time - up to two years. This type of monitoring can help diagnose someone who has infrequent symptoms.
In-Office & In-Hospital Tests
If you are having symptoms of cardiovascular disease, your physician will likely recommend tests to gather more information about the nature and severity of the problem. These tests can be as simple as taking your blood pressure in the doctor’s office or as complex as scheduling an appointment for a high-tech imaging test to view your blood vessels from the inside.
Part of your physician’s toolkit for diagnosing and guiding treatment of cardiovascular disease will be laboratory tests. These tests, along with other in-office or in-hospital diagnostic tests such as electrocardiogram (ECG, EKG) and stress testing, and wearable or implantable longer-term monitors for at home testing, can help complete a diagnostic picture of your cardiovascular health.
Magnetic Resonance Imaging (MRI)/Magnetic Resonance Angiogram (MRA)
When magnetic resonance imaging (MRI) is used to diagnose problems in the blood vessels, the test is often called a magnetic resonance angiogram (MRA). MRA is a type of imaging; that is, it creates images of the blood vessels so a physician can identify problems.
Office Visit/Physical Exam
The first step in the process of diagnosing and treating cardiovascular disease is a visit with your doctor to discuss your risk factors for developing cardiovascular disease, as well as any cardiac symptoms you may be having. Your doctor will ask how these symptoms impact your daily activities, how long you have noticed them and how often they occur and under what conditions. For example, do you notice symptoms when you are lifting a bag of groceries, working out at the gym, walking or just sitting quietly?
Platelet Function Test
A platelet function test measures the rate at which your blood clots. Physicians who are treating cardiovascular patients will often order a platelet function test to see if antiplatelet medications that have been prescribed to prevent blood clots are working at their intended level. Platelet function tests can also be used to help identify the cause of excessive bleeding or to see if bleeding is a risk during surgery.
Radionuclide Angiogram/MUGA Scan
A radionuclide angiogram is a test used to gather images of the heart throughout its pumping cycle. You may also hear it referred to as a MUGA scan (multigated acquisition scan) or blood pool scan. The test can help assess how well your heart is pumping by measuring what is called the “ejection fraction,” the amount of blood that is pumped out of the heart’s two lower chambers (the ventricles).
If your doctor suspects you may have blockages in the coronary arteries that supply blood to your heart or other heart problems, you may be scheduled for a stress test. This test, sometimes called an exercise stress test, measures how well your heart functions when it has to work harder.
Transcranial Doppler (TCD) is a form of ultrasound. You may already be familiar with ultrasound technology because of its wide range of uses in diagnosing medical conditions and in monitoring during pregnancy. Transcranial Doppler is ultrasound that is performed at the base of the brain to assess the risk of stroke.
An ultrasound test allows your physician to see blockages or narrowing in your blood vessels and determine the size of your kidneys. When performed in the heart, ultrasound is called echocardiography. Duplex ultrasound can generate images of the walls of a blood vessel as well as measure the rate at which blood is flowing through a vessel.