How Is Heart Disease Diagnosed?

Medically reviewed by Gerhard Whitworth, RN on February 16, 2018Written by Valencia Higuera on September 2, 2014

Testing for heart disease

Heart disease is any condition that affects your heart, such as coronary artery disease and arrhythmia. According to the Centers for Disease Control and Prevention (CDC), heart disease is responsible for 1 in 4 four deaths in the United States each year. It’s a leading cause of death in both men and women.

To diagnose heart disease, your doctor will perform a series of tests and evaluations. They may also use some of these tests to screen you for heart disease before you develop noticeable symptoms.

Symptoms of heart disease

Symptoms of a heart problem can include:

  • fainting
  • slow or fast heartbeat
  • chest tightness
  • chest pain
  • shortness of breath
  • sudden swelling in your legs, feet, ankles, or abdomen

If you have any of these symptoms, you should schedule an appointment with your doctor. Early diagnosis and treatment can help lower your risk of complications, like heart attack or stroke.

Physical exam and blood tests

During your appointment, your doctor will ask you about your symptoms and your family medical history. They’ll also check your heart rate and blood pressure.

Your doctor may also order blood tests. For example, cholesterol tests measure the levels of fat and cholesterol in your bloodstream. Your doctor can use these tests to help determine your risk of heart disease and heart attack.

A complete cholesterol test checks four types of fats in your blood:

  • Total cholesterol is the sum of all cholesterol in your blood.
  • Low-density lipoprotein (LDL) cholesterol is sometimes called “bad” cholesterol. Too much of it causes fat to build up in your arteries, which reduces blood flow. This can lead to a heart attack or stroke.
  • High-density lipoprotein (HDL) cholesterol is sometimes called “good” cholesterol. It helps carry away LDL cholesterol and clear your arteries.
  • Triglycerides are a type of fat in your blood. High levels of triglycerides are often associated with diabetes, smoking, and excessive alcohol consumption.

Your doctor may also order C-reactive protein (CRP) tests to check your body for signs of inflammation. They can use the results of your CRP and cholesterol tests to assess your risk of heart disease.

Noninvasive tests for heart disease

After completing a physical examination and blood tests, your doctor may order additional noninvasive tests. Noninvasive means the tests don’t involve tools that break the skin or physically enter the body. There are many noninvasive tests available to help your doctor check for heart disease.

Electrocardiogram

An electrocardiogram (EKG) is a short test that monitors the electrical activity in your heart. It records this activity on a strip of paper. Your doctor may use this test to check for an irregular heartbeat or heart damage.

Echocardiogram

An echocardiogram is an ultrasound of your heart. It uses sound waves to create a picture of your heart. Your doctor may use it to evaluate your heart valves and heart muscles.

Stress test

To diagnose heart problems, your doctor may need to examine you while you’re doing strenuous activity. During a stress test, they may ask you to ride a stationary bike or walk or run on a treadmill for several minutes. They’ll monitor your body’s reaction to stress as your heart rate increases.

Carotid ultrasound

A carotid duplex scan uses sound waves to create pictures of your carotid arteries on both sides of your neck. It allows your doctor to check for a buildup of plaque in your arteries and assess your risk of stroke.

Holter monitor

If your doctor needs to monitor your heart over a period 24 to 48 hours, they’ll ask you to wear a device called a Holter monitor. This small machine works like a continuous EKG. Your doctor can use it to check for heart abnormalities that can go undetected on a normal EKG, such as arrhythmias, or irregular heartbeats.

Chest X-ray

A chest X-ray uses a small amount of radiation to create images of your chest, including your heart. It can help your doctor determine the cause of shortness of breath or chest pains.

Tilt table test

Your doctor may perform a tilt table test if you’ve fainted. They’ll ask you to lie on a table that moves from a horizontal to a vertical position. As the table moves, they’ll monitor your heart rate, blood pressure, and oxygen level. The results can help your doctor determine whether your fainting was caused by heart disease or another condition.

CT scan

A CT scan uses multiple X-ray images to create a cross-sectional image of your heart. Your doctor may use different types of CT scans to diagnose heart disease. For example, they may use a calcium score screening heart scan to check for calcium deposits in your coronary arteries. Or they may use coronary CT angiography to check for fat or calcium deposits in your arteries.

Heart MRI

In an MRI, large magnets and radio waves create images of the inside of your body. During a heart MRI, a technician creates images of your blood vessels and heart while it’s beating. After the test, your doctor can use the images to diagnose many conditions, such as heart muscle diseases and coronary artery disease.

Invasive tests to diagnose heart disease

Sometimes noninvasive tests don’t provide enough answers. Your doctor may need to use an invasive procedure to diagnose heart disease. Invasive procedures involve tools that physically enter the body, such as a needle, tube, or scope.

Coronary angiography and cardiac catheterization

During cardiac catheterization, your doctor inserts a long flexible tube through a blood vessel in your groin or other part of your body. Then they move this tube toward your heart. Your doctor can use it to conduct tests to check for blood vessel problems and heart abnormalities.

For example, your doctor may complete a coronary angiography with catheterization. They’ll inject a special dye into the blood vessels of your heart. Then they’ll use an X-ray to look at your coronary arteries. They can use this test to look for narrowed or blocked arteries.

Electrophysiology study

If you have abnormal heart rhythms, your doctor may conduct an electrophysiology study to determine the cause and best treatment plan. During this test, your doctor feeds an electrode catheter through your blood vessel to your heart. They use this electrode to send electric signals to your heart and create a map of its electrical activity.

Your doctor may try to restore your natural heart rhythm by prescribing medications or other treatments.

When to see your doctor

If you suspect you may have heart disease, make an appointment with your doctor. Factors that put you at a higher risk for heart disease include:

  • family history of heart disease
  • history of smoking
  • obesity
  • poor diet
  • age

Your doctor may perform a physical examination, order blood tests, or use other tests to check for problems with your heart or blood vessels. These tests can help them diagnose heart disease and develop a treatment plan.

Complications of heart disease include heart attack and stroke. You can reduce the risk of complications with early diagnosis and treatment. Talk with your doctor if you have any concerns. They’ll teach you how to identify symptoms of heart disease and maintain a healthy heart.

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