Coronary Artery Disease

Diagnosis

Mayo Clinic doctors trained in the diagnosis and treatment of heart disease (cardiologists) work with other heart care specialists to diagnose and treat people who have coronary artery disease (CAD).

Your cardiologist uses advanced tools to diagnose coronary artery disease, rule out other possible causes of your symptoms and determine the most appropriate treatment. Your cardiologist diagnoses you with CAD through a physical examination, discussion of heart disease risk factors, review of family medical history and invasive and noninvasive diagnostic tests.

Your testing may include:

• Electrocardiogram (ECG or EKG). In this noninvasive test, your doctor places electrodes (sensor patches with wires attached) on your skin to measure your heart's electrical impulses. An ECG may show evidence of a heart attack, lack of blood supply to your heart or heart rhythm disturbances.
• Blood tests. A blood test identifies certain heart enzymes that leak into the blood if CAD has damaged your heart. It can also be used to check your cholesterol level and other risk factors for CAD.
• Chest X-ray. An X-ray shows the size and shape of your heart and can reveal damage, such as heart failure caused by coronary artery disease or a heart attack.
• Stress test. During a stress test, you exercise on a treadmill or stationary bicycle, or take a drug to simulate heart activity during exercise, while an electrocardiogram (ECG) monitors your heart. Your doctor also may monitor you using an echocardiogram, nuclear scan or PET scan during your stress test.
• Echocardiogram (Doppler echocardiogram). Through a hand-held device (transducer) on your chest, sounds waves bounce off your heart to produce detailed images of your heart's size, structure and function. The echocardiogram also shows heart valve function and some blood flow problems.
• Nuclear scan – Single-photon emission computerized tomography (SPECT). In this test, your doctor injects a small amount of radioactive material into your bloodstream. Special cameras show the flow of blood and can reveal a lack of blood supply to your heart.
• Positron emission tomographic scan (PET). A PET scan defines areas of your heart with altered blood supply and can help to identify areas of your heart damaged previously.
• Angiogram (coronary catheterization). The angiogram is the most precise test to determine the location and severity of CAD. Your doctor inserts a long, thin, flexible tube (catheter) into an artery in your leg or wrist and guides the catheter to your heart using X-ray imaging. Your doctor injects a special dye into the catheter, and blockages in your heart arteries become visible under X-ray. In most cases, your doctor can treat blockages immediately using catheter-assisted procedures such as angioplasty or stent placement.
• Magnetic resonance imaging (MRI). This test uses magnetic energy to generate highly detailed images of the structure and function of your heart, including damaged tissue from previous heart attacks.
• CT scan. Your doctor may be able to look at your larger coronary arteries using a CT scanner. Mayo Clinic in Minnesota installed the first 64-slice high-resolution CT scanner in the United States.

Read more about electrocardiogram, chest X-ray, stress test, echocardiogram, SPECT scan, angiogram, MRI and CT scan at MayoClinic.com.