What diagnostic tests for heart disease will I need?

Tests Your Doctor May Request Your doctor may diagnose your heart disease with any of the following tests:

  • chest X-ray
  • electrocardiography, also called an ECG or EKG
  • exercise stress test
  • echocardiography
  • stress test with radionuclide imaging
  • coronary angiography or arteriography
  • magnetic resonance imaging, called an MRI
  • computed tomography, also called CT; which includes electron-beam CT; and ultrafast CT
  • cardiac positron emission tomography, also called cardiac PET
  • single photon emission computed tomography, also called SPECT

Several tests can help your doctor determine if you have coronary heart disease and how severe it is. The tests your doctor chooses for you will depend on:


  • your risk factors
  • your personal history of heart problems
  • your current symptoms

Many of the tests available to diagnose heart disease are painless and do not involve needles or tubes. Doctors call these kinds of tests noninvasive. In most cases, your doctor will begin with the simplest and least invasive tests. If your test results warrant them, your doctor may order more complicated tests. Because each test provides different information, you may need more than one test. Some of the tests are newer and may be available only at larger medical centers. Others may be available at your doctor's office.

Here are some of the tests your doctor may request:

Chest X-ray. For this simple test, you stand in front of a screen containing film. X-ray beams pass through your chest and cast shadows on the film. The film is then developed. By taking this simple X-ray of the chest, doctors can tell several things about your heart. First, the size of your heart can be seen and measured. Next, many types of birth defects involving the heart can be identified. Furthermore, if your heart is not pumping hard enough, a chest X-ray will show a buildup of fluids or congestion in the lungs.

Electrocardiography, also called ECG or EKG. This is a painless test in which wires with pads are attached to your chest, arms, and legs from a recording machine. The machine reads the electrical current that is present in your heart. This recording is printed on paper that your doctor can review. The test is done while you are resting on a table or bed. Its purpose is to check the rhythm of your heart and to check for any areas of your heart muscle that may be damaged.

Exercise stress test. This test is similar to an EKG. Wires with pads are attached to your chest. Then a machine records the electrical activity of your heart while you are walking on a treadmill or riding a stationary bike. This type of exercise makes your heart use more oxygen than when you are just resting. A stress test allows the doctor to tell whether your heart is getting enough oxygen and whether you have a normal heart rhythm. It can reveal heart problems that may not be noticeable when you are at rest.

Echocardiography. This test uses harmless ultrasound waves to obtain pictures of your heart valves and heart muscle. It also shows how hard your heart can pump by measuring how fast the blood flows through it. It is useful in seeing if there has been any damage to your heart after a heart attack. It is one of the best ways to make sure that the valves in your heart are working properly.

Stress test with radionuclide imaging. Your doctor may want to take a closer look at how a stress test affects your heart. To do this, a technician will inject dye into a vein in your arm right after you exercise. This will allow your doctor to get a better view of how much blood is flowing to different parts of your heart. You then lie on a table under a scanner that takes a series of images or pictures. Another set of pictures is taken after your heart has been at rest an hour or two. By comparing the two sets of images, your doctor can get an idea of how much blood is getting to your heart.

Cardiac catheterization with coronary angiography, digital cardiac angiography, or digital subtraction angiography. During this test, your doctor places a small, thin catheter or tube in a blood vessel in either your arm or your groin. Then, your doctor moves the catheter up to the heart and injects a small amount of dye through it. A special camera takes a video of your blood with the dye. The video captures the dyed blood as it flows into all the vessels that supply your heart. This helps your doctor see best which blood vessels are clogged. It also tells your doctor how much of each blood vessel is clogged with plaque. It can reveal a lot about how the valves in your heart are working and how hard your heart is able to pump. During this test, you are given medicine by vein to help you relax so that you will not feel any pain.

Other tests. Doctors in large medical centers are now finding other ways to see how the heart is working and to look at its blood supply. These other ways include the following:

  • magnetic resonance imaging, also called MRI
  • computed tomography, also called CT, including electron-beam CT, and ultrafast CT
  • cardiac positron emission tomography, also called cardiac PET
  • single photon emission computed tomography, also called SPECT

These tests draw on machines and techniques not yet routinely available for evaluating heart disease. But they have been often used to view other parts of the body. Your doctor can tell you where these tests are available and whether they would be appropriate for you.


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