Tests Commonly Used to Diagnose Heart Disease

From Electrocardiograms to Radioactive Imaging

Electrocardiogram (ECG)
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Because there are many types of cardiac disease, each affecting different parts and functions of the cardiovascular system, we need a battery of tests to make an accurate diagnosis. Some are used to identify abnormalities within the heart or blood vessels. Others aim to see how well the organs are performing with respect to your age, health, and personal characteristics.

General Heart Tests

These tests are commonly used as a general screening for heart disease.

They are typically used to establish a baseline in people with no known cardiac disease. Over time—sometimes weeks, sometimes years—the tests can be repeated to see if there is any deterioration or improvement from the baseline function. Some of the routine procedures include:

  • Electrocardiogram (ECG) is a test that measures the electrical activity of your heart and the rhythm and strength of your heartbeat.
  • Echocardiogram, a form of ultrasound, uses sound waves to create pictures of your heart's chambers, valves, walls, and blood vessels.
  • Stress Testing, also known as stress ECG, lets your doctor know how well your heart responds to activity as you walk at a moderate pace on a treadmill.

Tests for Coronary Artery Disease

These tests are commonly ordered when doctors are suspicious of the coronary artery disease (CAD). They are typically performed alongside an ECG and stress test to investigate the possible causes.

Certain patterns on an ECG, for example, are characteristically seen prior to a myocardial infarction (heart attack). Similarly, stress tests can be used to detect signs of angina indicative of CAD. When used in conjunction with other diagnostic tests, these technologies can help support a diagnosis and direct the course of treatment.

Among them:

  • Thallium and cardiolyte testing use a radioactive tracer injected into the blood to evaluate the blood flow through the heart and circulatory system.
  • MUGA scans also use a radioactive tracer to take pictures of your heart as it pumps blood with every heartbeat.
  • Calcium scans use a special X-ray technique called a computed tomography (CT) scan to check for the buildup of calcium in the plaque of arterial walls.
  • Cardiac MRI, also known as magnetic resonance imaging, uses magnetic waves to create pictures of your heart from many angles.
  • Cardiac catheterization and angiography involve the insertion of a thin, flexible tube called a catheter into an artery of the leg or arm which is fed to the arteries in the heart. During angiography, dye is injected through the catheter to create X-ray images of the surrounding blood vessels.
  • Transesophageal echocardiogram is a means of obtaining clearer images of the heart structure by inserting a flexible ultrasound into the esophagus (feeding tube).

Tests for Heart Rhythm Problems

These tests are commonly used to detect and diagnose heart rhythm disturbances known as arrhythmia. They can also be used to help determine the cause of syncope (fainting).

Among them:

  • Holter monitoring, also known as event monitoring, is a small portable ECG device which can be worn by the patient to monitor the heartbeat for 24 to 48 hours.
  • Electrophysiology study, also known as an EP study, is a minimally invasive procedure in which a catheter is fed into an artery to evaluate the electrical system of the heart using two large magnetics placed to either side of the patient.
  • Tilt table testing is a test in which you lie flat on a table and are monitored as it is gradually tilted to 60 degrees to find the cause of fainting spells. During the procedure, you would be hooked up to an ECG while your blood pressure and blood oxygen levels are continually monitored.

    Sources:

    Chou. R. "High-Value Care Task Force of the American College of Physicians. Cardiac Screening with Electrocardiography, Stress Echocardiography, and Myocardial Perfusion Imaging: Advice for High-value Care from the American College of Physicians." Ann Intern Med. 2015; 162:438-47. DOI: 10.7326/M14-1225.

    Moyer, V. "U.S. Preventive Services Task Force. Screening for Coronary Heart Disease with Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement." Ann Intern Med. 2012; 157:512-8. DOI: 10.7326/0003-4819-157-7-201210020-00514.

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