Coronary heart disease (CHD) is usually diagnosed after a risk assessment and some further tests.
If your doctor thinks you may be at risk of developing CHD, they may carry out a risk assessment for cardiovascular disease, heart attack or stroke. This may be carried out as part of an NHS Health Check.
Your doctor will ask about your medical and family history, check your blood pressure, and do a blood test to assess your cholesterol level.
Before having the cholesterol test, you may be asked not to eat for 12 hours so there is no food in your body that could affect the result.
Your GP or practice nurse can carry out the blood test. A sample will be taken either using a needle and a syringe or by pricking your finger.
Your GP will also ask about your lifestyle, how much exercise you do and whether you smoke. All these factors will be considered as part of the diagnosis.
To confirm a suspected diagnosis, you may be referred for more tests. A number of different tests are used to diagnose heart-related problems, including:
An ECG records the rhythm and electrical activity of your heart. A number of electrodes (small sticky patches) are put on your arms, legs and chest. The electrodes are connected to a machine that records the electrical signals of each heartbeat.
Although an ECG can detect problems with your heart rhythm, an abnormal reading does not always mean there is anything wrong. Similarly, a normal reading does not always rule out heart problems.
In some cases, you may have an exercise ECG test, or "stress test". This is when an ECG recording is taken while you are exercising (usually on a treadmill or exercise bike). If you experience pain while exercising, the test can help identify whether your symptoms are caused by angina, which is usually a result of CHD.
An X-ray may be used to look at the heart, lungs and chest wall. This can help rule out any other conditions that may be causing your symptoms.
An echocardiogram is similar to the ultrasound scan used in pregnancy. It produces an image of your heart using sound waves.
The test can identify the structure and pumping function of the heart, the thickness of the heart muscle and the movement of each heart valve, and can be used to create a detailed picture of the heart.
During an echocardiogram, you will be asked to remove your top and a small handheld device called a transducer will be passed over your chest.
Lubricating gel is put on to your skin to allow the transducer to move smoothly and make sure there is continuous contact between the sensor and the skin.
In addition to cholesterol testing, you may need to have a number of blood tests to monitor the activity of the heart. These may include cardiac enzyme tests, which can show whether there has been recent damage to the heart muscle.
Coronary angiography, also known as a cardiac catheter test, can identify whether the coronary arteries are narrowed and how severe any blockages are. It also provides information about the pressure inside your heart chambers and how well your heart is functioning.
In an angiogram, a catheter (flexible tube) is passed into an artery in your groin or arm and guided into the coronary arteries using X-rays. A dye is injected into the catheter to show up the arteries supplying your heart with blood.
A number of X-ray pictures are then taken, which will highlight any blockages. It is usually performed under local anaesthetic.
A coronary angiogram is relatively safe and serious complications are rare. The risk of having a heart attack, stroke or dying during the procedure is estimated at about 1 or 2 in every 1,000.
However, after having a coronary angiogram you may experience some minor side effects, including:
- a slightly strange sensation when the dye is put down the catheter
- a small amount of bleeding when the catheter is removed
- a bruise in your groin or arm
Radionuclide tests can indicate how strongly your heart pumps and show the flow of blood to the muscular walls of your heart. They provide more detailed information than the exercise ECG test.
During a radionuclide test, a small amount of a radioactive substance called an isotope is injected into your blood (sometimes during exercise).
If you have difficulty exercising, you may be given some medication to make your heart beat faster. A camera placed close to your chest picks up the radiation transmitted by the isotope as it passes through your heart, highlighting areas where there is poor blood supply.
Magnetic resonance imaging (MRI)
An MRI scan can be used to produce detailed pictures of your heart. During an MRI scan, you lie inside a tunnel-like scanner that has a magnet around the outside. The scanner uses a magnetic field and radio waves to produce images.
Computerised tomography (CT) scan
A CT scan uses X-rays and a computer to create detailed images of the inside of your body. During a CT scan, you lie on a bed while a small tube that takes X-rays moves and rotates around your body.
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