A primary care physician can find early risks related to coronary artery disease. Often they will do:
- A routine medical history
- A routine physical
- An in-office electrocardiogram (ECG)
A heart specialist (cardiologist) may do more tests to diagnose coronary artery disease. Below are some of the common ones.
Stress Test
A stress test shows how the heart works when it is stressed (working hard). People usually exercise on a treadmill while pictures of the heart are taken. The images may be taken using an electrocardiogram or an echocardiogram.
If a person cannot exercise, they may get a medication that stresses the heart. A stress test can help show signs or symptoms of heart disease. It can also show how severe the heart disease is.
Electrocardiogram (ECG or EKG) and ECG Stress Test
This simple, painless test measures the electrical activity of the heart. It uses electrodes placed on the chest and other parts of the body. The EKG or ECG is done while a person is lying down. But the ECG stress test may happen while a person is exercising on a treadmill or bicycle. This monitors how the heart responds to increasing levels of physical activity.
Echocardiogram (Echo)
An echocardiogram is an ultrasound (or sonogram) of the heart. It uses sound waves to create an image of the inside of the beating heart. This test is used to visualize the walls of the heart, its four chambers, and the valves between the chambers. This test can tell if the heart is working correctly.
Holter Monitor
The heart’s electrical activity can be tested over one or two days with a portable monitor at home. A person wears the monitor and can do all normal activities, except for showering. The monitor goes back to the provider’s office for analysis of results.
Nuclear Stress Test
If a person has symptoms like chest pain or shortness of breath, the healthcare professional may order a nuclear stress test. A person receives an injection of radioactive dye and images of the heart are taken at rest, and again after exercise. The nuclear stress test can find:
- Damaged areas in the heart or related arteries
- An enlarged heart
- How well the heart is pumping blood
Chest X-ray
A chest x-ray can show whether parts of the heart are enlarged, or if there is fluid buildup in the lungs. These can be signs of heart failure, a heart valve problem, or thickening of the heart muscle.
Cardiac Catheterization (Angiogram)
Cardiac catheterization usually tests coronary artery disease, which means that arteries to the heart are narrow or completely blocked and are blocking the blood flow to the heart muscle. During this test, a long, thin tube (catheter) is put into a blood vessel in the arm, groin, or neck and guided to the heart. A dye is injected into the tube and X-ray pictures are taken to show the dye traveling through the heart and any blockages in the coronary arteries.
Cardiac MRI
Cardiac MRIs use a strong magnet and radio waves to create images of the inside of the heart. This test can provide detailed information about how heart valves and other parts of it are working.
Coronary Calcium CT Scan
In coronary artery disease, calcium builds up in plaques in the walls of arteries. This narrows the blood vessels and raises the risk of a heart attack.
Healthcare professionals can estimate the risk by checking your coronary calcium “score”—even when you have no symptoms.
During the short scan a person:
- Lies on a table
- Has electrodes (wires) attached to their chest
- Gets injected with a dye.
- Gets exposed to the same amount of radiation as 33 chest x-rays.
Repeated scans raise your cancer risk. Only people who have a 10–20 percent chance of having a heart attack within the next 10 years should get this type of scan.
Last Updated February 2023