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Tests to confirm coronary artery disease (CAD) may be ordered if a patient experiences
symptoms or if age or family history warrant further examination. Angina (chest pain)
and/or dyspnea (shortness of breath) may accompany CAD. Other symptoms include tightness,
heaviness, burning sensation, pressure, squeezing, or pain behind the breastbone or less
commonly pain also in the arms, neck or jaws, nausea and vomiting, fatigue, sweating, or
weakness.
Diagnostic Tests Used to Confirm CAD
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Chest x-ray: A chest x-ray images the heart and
surrounding thoracic anatomy, shows heart size and shape and reveals whether the heart is
misshapen or enlarged due to disease. Abnormal calcification (hardened blockage due to
cholesterol build up) in the main blood vessels and fluid in the lungs (possible
indication of CHF) can also be seen. Chest x-rays can also be used to image pacemakers and
artificial heart valves to check for correct positioning. |
- Electrocardiogram (ECG or EKG): An electrocardiogram is a graphical record of
the electrical activity of the heart. A normal ECG, in most cases, rules out the presence
of other cardiac diseases. An abnormal ECG indicates the presence of a cardiac disease and
further investigations are performed. An ECG can be beneficial in detecting the disease
and sometimes even the extent of the disease.
- Stress test: A stress test involves taking an ECG before, during and after a
treadmill workout to detect cardiac disease and/or damage, including the extent of CAD.
However, false positive results are possible with stress tests.
- Echocardiogram (heart ultrasound): This diagnostic technique is an excellent
tool to provide details of the cardiac structures – vessels, valves, and muscle.
Echocardiography is a non-invasive exam in which images are acquired and viewed in real
time without the use of radiation. Echocardiography is often useful in studying the
beating heart and provides some information on functional abnormalities of the heart wall,
valves and blood vessels. Echocardiography with Doppler is used to measure blood flow
across valves, across septal defects (shunts), extent of regurgitations, etc. Color flow
mapping capability is extremely useful in the detection of shunts. Abnormal operation of
the valves can be detected by studying the opening and closing function versus normal
valve function. Echocardiography may also be used to study congenital
heart defects such as a septal defect (a hole in the wall that separates the two
chambers of the heart).
- Nuclear cardiology: Nuclear cardiology (also called radionuclide scanning or stress
thallium imaging) allows visualization of the function of the heart. Myocardial perfusion
imaging is the most common nuclear cardiology test to assess CAD. This noninvasive test
can identify and quantify areas of inadequate blood supply within the myocardium (heart
muscle), detect scaring of the myocardium, and assess the heart's pumping function.
Nuclear cardiology is a cost-effective tool to help determine which patients are
candidates for coronary angiography, revascularization, or coronary artery bypass surgery.
Nuclear cardiology is also useful to monitoring the effectiveness of coronary
revascularization or bypass surgery.
- Ambulatory monitoring: If no abnormality, disease or damage is detected and the
patient still feels uneasy when performing stressful activities (such as climbing stairs)
but feels okay under normal activity, then an ambulatory monitor may be used. An
ambulatory monitor is a portable ECG system (often worn around the waist) that
continuously monitors the heart’s electrical activity.
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Coronary angiography: The procedure, performed in a cardiac catheterization
laboratory, is minimally invasive and involves placing a catheter in a major blood vessel
and injecting a dye (radio-opaque material) to create an image of the heart and coronary
arteries. Angiography is excellent for imaging blockages in
the coronary vessels. Angiography can also image the beating heart in real time and may be
useful in evaluating the function of the heart chambers. Angiography is often used for
diagnosing heart disorders, but is also a valuable tool for guiding therapeutic treatment
of the coronary arteries (e.g. angioplasty). In addition to diagnosing coronary artery
disease, angiography is useful for diagnosing or treating children with congenital heart
diseases and is also used during pacemaker implantation to help position the pacemaker
leads. |
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Cardiac magnetic resonance (MR) imaging: Magnetic
resonance (MR) imaging of the heart is a unique application that can provide valuable
information in certain situations. Cardiac MR provides non-invasive imaging of the heart.
Ultra-fast 2D and 3D imaging techniques coupled with the latest MR hardware now allow
improved diagnosis in as little as a single breath-hold. New techniques are also being
developed which allow first pass perfusion imaging of the heart. Cardiac MR applications
and techniques are continuously improving and their use varies from center to center.
However, cardiac MR applications appear to be very promising and may provide an excellent
means to diagnose a number of heart conditions without requiring the use of x-rays or
contrast injection, as with conventional x-ray angiography. |
Updated: February 29, 2008
Return to Coronary Artery Disease Overview |
