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Diagnosing heart disease

An ECG printout

Doctors may suggest more than one of these common tests to understand the extent of a person's heart disease and what treatments may help.

Diagnosing heart disease isn't a one-size-fits-all endeavor. Many tests are available. Doctors tend to start with the simple ones and then use more complicated ones later, if needed.

The choice of which tests to use—and how many—depends on a person's risk factors, history of heart problems, current symptoms and the doctor's interpretation of these factors, according to the American Heart Association (AHA).

A doctor may order tests if a person has symptoms of heart trouble or has had a cardiac event, such as a heart attack. Tests may also be ordered for people who have risk factors for heart disease.

The purpose of all of the tests is to gauge the health of the heart and the blood vessels that supply it with nourishment.

Here's a rundown from the AHA and the National Heart, Lung, and Blood Institute on some of the more common tests and how they help diagnose problems.

Noninvasive tests

Noninvasive tests don't require inserting needles, fluids or instruments into the body. They include:

Chest x-rays, which can show whether the heart is enlarged or if fluid is building up in the lungs as a result of a heart attack.

Echocardiography (echo), which uses sound waves (ultrasound) to create a moving picture of the heart chambers and valves. The test offers information about the size and shape of the heart and how well its chambers and valves are working.

Electrocardiography (EKG or ECG), which use electrodes on the chest to record the heart's electrical activity as it beats. EKGs can show abnormal heartbeats, heart muscle damage, blood flow problems and heart enlargement.

Holter monitors (also called ambulatory electrocardiography), which are small, battery-operated monitors that record the heart's electrical activity over a 24- to 48-hour period. Results help doctors understand rhythm problems and how the heart responds to normal activity.

Stress tests (also called treadmill tests or exercise ECGs), which map the heart's electrical activity while a person exercises, usually on a treadmill or stationary bike. Stress tests can help diagnose coronary artery disease and the cause of a person's chest pain. They also help determine a safe level of exercise.

People who can't exercise—maybe because of arthritis—can take medicine to make their heart beat faster and pump harder instead of exercising during a stress test.

Invasive tests

Invasive tests involve inserting needles, catheters, dyes, fluids or instruments into the body, usually into a vein. They include:

Blood tests. They can measure levels of fats, cholesterol, sugar and proteins in the blood. Abnormal levels may show risk factors for heart disease.

Coronary angiography (also called angiogram, arteriography or cath). In this test, a small, flexible tube (catheter) is threaded through an artery, usually through the groin or arm and into the heart. A dye, visible by x-rays, is injected. As the heart pumps, pictures are taken to reveal blockages or show areas where the heart is weakened or damaged from lack of blood.

Thallium stress test (also called multiple-gated acquisition scanning, myocardial perfusion imaging or nuclear scan). In this test, a small amount of radioactive material is injected into a vein and a camera records how much is taken up by the heart muscle. The test shows blood supply and heart damage, and how well the heart's chambers are working.

Transesophageal echocardiography (TEE). In this test, a flexible tube fitted with a device that produces sound waves is passed through the throat into the esophagus to gather information about abnormal heart rhythms, heart function and heart structure.

Work with your doctor

If you need tests to check your heart, your doctor can help you determine the appropriate test or tests for your particular situation.

Results from these tests can help you and your doctor decide what course of treatment is best—lifestyle changes, medicines, surgeries, implanted devices or some combination of the four.

Reviewed 7/10/2023

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