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Diagnosis

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A variety of tests are used to diagnose the different forms and stages of CAD. Simple tests are usually given first, progressing to more complicated tests if these are needed. The specific tests used depend on the patient’s particular problems.

The doctor will start by:

• taking a medical history
• conducting a physical examination

Depending on the findings, a series of non-invasive and invasive tests may then be used to pinpoint accurately the specific type and stage of CAD. Invasive tests involve inserting needles, instruments or fluids into the body, while non-invasive tests do not. Once a diagnosis has been reached, treatment options can then be discussed.

Non-invasive tests include:

• electrocardiography/electrocardiogram (ECG), at rest, during exercise or stress, and over time (Holter monitoring)
• chest X-ray
• echocardiography/echocardiogram
• computed tomography (CT)
• magnetic resonance imaging (MRI)

Invasive tests include:

• nuclear imaging (e.g. positron emission tomography, PET)
• other imaging (e.g. coronary angiography)
• blood tests

Some invasive and non-invasive tests can be conducted under resting conditions or conditions of physical stress. This stress is generated using exercise (on a treadmill or exercise bike) or a drug in patients not able to exercise (e.g. due to obesity, arthritis or age). Testing under stress allows the doctor to assess how much activity a person can undertake comfortably (referred to as exercise tolerance). It also enables the doctor to bring on symptoms (and their underlying effects on the heart and blood vessels) so that these can be assessed. Stress testing is valuable in gauging the severity of CAD during the initial diagnostic phase, and after a heart attack or for assessing the benefit of treatment (e.g. after balloon angioplasty or during drug therapy). Stress testing may be combined with the use of imaging techniques and/or the use of imaging agents.

Glossary