Definitive Tests to Diagnose Heart Disease

In an ideal world, there would be one heart test that could tell you definitively whether you have heart disease. However, cardiologists are often challenged to make a heart disease diagnosis based on a combination of symptoms, such as chest pain, your personal and family history, and the results of imaging and stress tests.
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“History actually provides most of the information,” says cardiologist Dan Fintel, MD, a professor of medicine in the division of cardiology at the Northwestern University Feinberg School of Medicine in Chicago. “For most people, the condition is silent,” he says.

Steps to a Heart Disease Diagnosis

If you go to your doctor to find out whether you have heart disease, he will make the disease diagnosis by talking to you about your medical and family history. He will ask you about:

* Your family. Have people close to you (parents or siblings in particular) been diagnosed with heart disease or had a heart attack? Your doctor may also ask about related conditions, such as diabetes or a history of strokes.
* Your lifestyle. Your doctor will want to know some of the details of your diet, physical activity habits, and whether you smoke, drink alcohol, or use illicit drugs.
* Medications. Make sure your doctor knows about herbal products, over-the-counter supplements, vitamins, or pills that you are taking in addition to prescription medications.
* Your symptoms. A detailed description of your symptoms can help your doctor choose the right tests. Symptoms may include:
o Chest pain or discomfort, sometimes called angina. Describe the pain: where it is, how it feels, when it occurs, and how long it lasts. People often use words like stabbing, sharp, or squeezing, but be as specific as possible in your description of any discomfort you’ve experienced.
o Shortness of breath, and if it occurs during exertion, when at rest, or when you lie down to sleep.
o Dizziness or fainting
o Changes in your heartbeat’s rhythm (arrhythmia)
o Difficulty doing things you normally do, such as exercise, household chores, or being sexually intimate.

Your doctor will also order tests, such as:

* Blood tests for cholesterol, triglycerides, and other measures of heart health.
* Blood pressure test. Measuring blood pressure is part of routine doctor’s visits, but it's also an important part of diagnosing heart disease.
* Electrocardiogram (ECG or EKG). This test measures the electrical activity of your heart, and may show evidence of a previous heart attack. You may be also be given a Holter monitor, which is a portable version of this type of test, to wear for 24 to 48 hours.
* Stress tests. Because heart disease is sometimes silent, your doctor may order what Dr. Fintel calls “provocative tests” that are intended to find out how your heart is functioning by making it work harder in a supervised situation. There is an exercise-based stress test and, for people who cannot exercise, a pharmacological (drug-based) stress test.
* Imaging tests. There are a number of tests that help your doctor see the condition of your heart and blood vessels. Your doctor will select the tests he wants to use based on your symptoms. Heart imaging tests include:
o Chest X-ray — allows your doctor to see the size and shape of your heart and surrounding structures.
o MRI (magnetic resonance imaging) — cardiac MRIs produce a detailed image of your heart.
o Echocardiography — using sound waves, this test shows how your heart muscle and heart valves are working.
o Electron beam computed tomography (EBCT) — this scan lets your doctor measure calcium deposits — which may indicate coronary artery disease — and other heart characteristics.
o Cardiac catheterization/Coronary angiography — your doctor threads a catheter through an artery in the groin or arm into the coronary arteries, injects a dye, and takes special X-rays t so he can see and measure function inside your heart and coronary arteries.

Ruling Out Other Causes of Heart Symptoms
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One reason your doctor asks you all the questions he asks and orders the tests he orders is to rule out other conditions that could be causing your symptoms. Chest pain and other symptoms that indicate heart disease can have other causes, including arthritis of the front of the rib cage, lung conditions, damage to bones and muscles, or inflammation of the tissues around the heart.

Although the process of diagnosing heart disease seems lengthy, you’ll be glad to know the results when you get to the end. Then you and your doctor can talk about next steps
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