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Coronary artery disease (CAD)
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Coronary artery disease

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HEART & BLOOD

Heart Disease

HEART & BLOOD

Heart Attack & Failure

From MayoClinic.com

Screening and diagnosis

How can you know whether you have this silent, potential killer? Your doctor can help answer that question based on test results and your level of risk.

If you have risk factors for coronary artery disease, your doctor may want to test you for coronary artery disease, even if you don't have signs or symptoms of narrowed arteries. You may be referred to a cardiologist, a doctor who specializes in diagnosing and treating cardiovascular problems. The term cardiovascular refers to your body's circulatory system — your heart, arteries and veins.

In addition to a physical examination, taking your medical history and routine blood tests, your doctor may recommend these tests to diagnose coronary artery disease:

  • Electrocardiogram (ECG). In this test, which is sometimes called an EKG, patches with wires (electrodes) are attached to your skin to measure electrical impulses given off by your heart. This test can show evidence of a previous heart attack or one that's in progress. It can also yield other useful information, such as the status of your heart's electrical system. ECG readings taken continuously over a period of 24 hours or longer may help detect silent ischemia. This technique is called ambulatory electrocardiography monitoring, or Holter monitoring. Electrodes attached to your chest are connected to a portable monitor — about the size of a paperback book or smaller — that attaches to your belt or is carried by a shoulder strap. You wear the monitor for 24 hours as you go about your normal activities. Recorded abnormalities may show evidence of inadequate blood supply to your heart.

  • Echocardiogram. This test uses sound waves to produce an image of your heart. An echocardiogram can help identify whether an area of your heart has been damaged from lack of blood supply by assessing how well that area moves during each heartbeat. When combined with a stress test, an echocardiogram can also help identify areas of diminished blood flow to your heart.

  • Stress test. Stress tests help measure whether your heart is getting adequate blood supply. They may be used to evaluate symptoms such as chest pain or shortness of breath during exertion. Or if you have significant risk factors for coronary artery disease — even if you have no symptoms — a stress test can be used as a screening tool. There are several kinds of stress tests. During an exercise stress test, you walk on a treadmill or pedal a stationary bike while an ECG records your heart's response to an increasing workload. For people who can't exercise, a medication may be used to "stress" the heart and mimic the effects of exercise instead. Doctors also sometimes use imaging tests — an echocardiogram or a nuclear scan — to provide additional information by generating pictures of your heart during and after exercise or pharmacologic stress.

  • Coronary angiography (or arteriography). This has long been considered the definitive test for coronary artery disease. It can show specific sites of narrowing in coronary arteries. A small tube (catheter) is inserted into an artery in your arm or groin and threaded to your heart. A dye is injected into the catheter. As the dye flows through your coronary arteries, your doctor can see narrow areas and blockages with the help of X-rays.

  • Coronary magnetic resonance angiography. This technique uses magnetic waves to produce a three-dimensional image of your coronary arteries to check for narrowings or blockages. This technique is still being developed, but it has the advantage of producing images of your coronary arteries with a noninvasive procedure.

  • Nuclear scan. This test also helps identify blood flow problems to your heart. Trace amounts of radioactive material, such as thallium or a compound known as Cardiolite, are injected into your bloodstream. Special cameras can detect areas in your heart that receive less blood flow.

  • Electron beam computerized tomography (EBCT). This test, also called an ultrafast CT scan, can detect calcium within plaques that narrow coronary arteries. Most, but not all, plaques contain some calcium. If a substantial amount of calcium is discovered, coronary artery disease is likely.

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