Tests for Coronary Artery Disease
Understanding Coronary Artery Disease Tests: A Complete Guide to Heart Disease Diagnosis
When doctors suspect coronary artery disease (CAD), they use several different tests to confirm the diagnosis and understand how severe the condition is. These tests help determine the best treatment approach for each patient. Here's what you need to know about the most common tests used to diagnose and evaluate coronary artery disease.
What Is Coronary Artery Disease?
Coronary artery disease occurs when the blood vessels that supply your heart muscle become narrowed or blocked by fatty deposits called plaque. This reduces blood flow to the heart, which can cause chest pain, shortness of breath, and potentially lead to heart attacks.
Initial Tests for Coronary Artery Disease
Electrocardiogram (EKG or ECG)
An electrocardiogram is often the first test doctors perform when evaluating heart problems. This simple, painless test measures the electrical activity of your heart using small patches attached to your chest, arms, and legs.
What it shows: An EKG can reveal irregular heart rhythms, signs of previous heart attacks, and areas where the heart muscle isn't getting enough blood. However, a normal EKG doesn't rule out coronary artery disease, especially if symptoms only occur during physical activity.
How long it takes: About 5-10 minutes
Blood Tests
Several blood tests help doctors assess your heart health and risk factors for coronary artery disease.
Cholesterol levels: These tests measure different types of cholesterol and triglycerides in your blood, which are key risk factors for developing coronary artery disease.
Cardiac biomarkers: These tests are only used when doctors suspect a heart attack has occurred or is currently happening. When heart muscle is damaged, it releases specific proteins like troponin and CK-MB into the bloodstream. These tests aren't part of routine coronary artery disease screening.
Blood glucose: This test screens for diabetes, which is a major risk factor for developing coronary artery disease. High blood sugar levels over time can damage blood vessels and increase the likelihood of heart problems.
Stress Testing
Stress tests evaluate how your heart performs when it needs to work harder, either through exercise or medication.
Exercise Stress Test
During this test, you'll walk on a treadmill or ride a stationary bike while connected to an EKG machine. The intensity gradually increases while doctors monitor your heart rate, blood pressure, and heart rhythm.
What it reveals: This test can detect coronary artery disease that only shows symptoms during physical activity. It also helps determine how much exercise is safe for you.
Duration: Typically 15-30 minutes including preparation
Stress Echocardiogram
This combines a stress test with an ultrasound of your heart (echocardiogram). Images of your heart are taken both before and immediately after exercise to compare how well different areas of your heart muscle are working.
Benefits: This test provides detailed information about heart function and can identify specific areas of the heart that aren't receiving adequate blood flow.
Nuclear Stress Test
A small amount of radioactive material is injected into your bloodstream, and special cameras track how it moves through your heart muscle during rest and after stress (exercise or medication).
What it shows: Areas of the heart that don't receive enough blood flow will show up differently on the images, helping doctors identify blocked or narrowed arteries.
Advanced Imaging Tests
Coronary Angiography (Cardiac Catheterization)
This is considered the gold standard for diagnosing coronary artery disease. A thin, flexible tube (catheter) is inserted through a blood vessel in your arm or groin and guided to your heart. Contrast dye is then injected to make your coronary arteries visible on X-ray images.
What it reveals: This test provides detailed images of your coronary arteries and can show exactly where blockages are located and how severe they are.
Additional benefits: If significant blockages are found, they can often be treated immediately during the same procedure with angioplasty and stent placement.
Recovery: Most people can go home the same day, though you'll need someone to drive you.
CT Coronary Angiography
This non-invasive test uses computed tomography (CT) scanning with contrast dye to create detailed images of your coronary arteries.
Advantages: No need for catheter insertion, faster procedure, and excellent for detecting blockages in people at moderate risk for coronary artery disease.
Limitations: May not be suitable for people with irregular heart rhythms, and the images aren't quite as detailed as traditional angiography.
Coronary Calcium Scoring
This CT scan measures the amount of calcium deposits in your coronary arteries. Calcium buildup is a sign of coronary artery disease, even before symptoms develop.
Who benefits: This test is particularly useful for people at intermediate risk for heart disease to help guide prevention strategies.
What the scores mean: Higher calcium scores indicate more extensive coronary artery disease and higher risk for future heart problems.
Echocardiography
An echocardiogram uses sound waves to create moving pictures of your heart. This painless test shows how well your heart chambers and valves are working.
Information provided: Heart size, pumping strength, valve function, and areas of heart muscle that may be damaged from previous heart attacks.
Types: Can be performed from outside the chest (transthoracic) or, for more detailed images, through the esophagus (transesophageal).
Choosing the Right Tests
Your doctor will recommend specific tests based on several factors:
Your symptoms and medical history
Physical examination findings
Risk factors like age, family history, diabetes, high blood pressure, and smoking
Results of previous tests
Your overall health and ability to undergo certain procedures
What Happens After Testing?
Once your tests are complete, your doctor will review all the results to:
Confirm whether you have coronary artery disease
Determine the severity and location of any blockages
Assess your overall heart function
Develop an appropriate treatment plan
Treatment options may include lifestyle changes, medications, procedures like angioplasty, or in some cases, coronary artery bypass surgery.
Preparing for Your Tests
Most coronary artery disease tests require minimal preparation, but your doctor may ask you to:
Avoid caffeine before stress tests
Fast before certain blood tests
Stop certain medications temporarily
Arrange transportation if sedation is involved
Wear comfortable clothes and shoes for exercise tests
The Bottom Line
Early detection and accurate assessment of coronary artery disease are crucial for preventing heart attacks and other serious complications. These tests help your healthcare team create a personalized treatment plan to protect your heart health and improve your quality of life.
If you're experiencing symptoms like chest pain, shortness of breath, or unusual fatigue, don't hesitate to discuss these concerns with your doctor. The sooner coronary artery disease is diagnosed and treated, the better your long-term outlook will be.
August 2025
Prepared by Professor Eric Lim for PEACHealth with background research and drafting assistance by LLM.