How Is Atherosclerosis Diagnosed?

Your doctor will diagnose atherosclerosis based on:

• Your medical and family histories
• Your risk factors
• The results of a physical exam and diagnostic tests

Specialists Involved

If you have atherosclerosis, a doctor, internist, or general practitioner may handle your care. Your doctor may send you to other health care specialists if you need expert care. These specialists may include:

• A cardiologist (a doctor who specializes in treating people with heart problems). You may see a cardiologist if you have coronary artery disease (CAD).
• A vascular specialist (a doctor who specializes in treating people with blood vessel problems). You may see a vascular specialist if you have peripheral arterial disease (PAD).
• A neurologist (a doctor who specializes in treating people with disorders of the nervous system). You may see a neurologist if you've had a stroke due to carotid artery disease.

Physical Exam

During the physical exam, your doctor may listen to your arteries for an abnormal whooshing sound called a bruit (broo-E). Your doctor can hear a bruit when placing a stethoscope over an affected artery. A bruit may indicate poor blood flow due to plaque.

Your doctor also may check to see whether any of your pulses (for example, in the leg or foot) are weak or absent. A weak or absent pulse can be a sign of a blocked artery.

Diagnostic Tests and Procedures

Your doctor may order one or more tests to diagnose atherosclerosis. These tests also can help your doctor learn the extent of your disease and plan the best treatment.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for atherosclerosis.

EKG (Electrocardiogram)

An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart.

Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current heart attack.

Chest X Ray

A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels.

A chest x ray can reveal signs of heart failure.

Ankle/Brachial Index

This test compares the blood pressure in your ankle with the blood pressure in your arm to see how well your blood is flowing. This test can help diagnose PAD.

Echocardiography

This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working.

The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Computed Tomography Scan

A computed tomography, or CT, scan creates computer-generated images of the heart, brain, or other areas of the body. The test can often show hardening and narrowing of large arteries.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are performed. If you can't exercise, you're given medicine to speed up your heart rate.

When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries narrowed by plaque can't supply enough oxygen-rich blood to meet your heart's needs. A stress test can show possible signs of CAD, such as:

• Abnormal changes in your heart rate or blood pressure
• Symptoms such as shortness of breath or chest pain
• Abnormal changes in your heart rhythm or your heart's electrical activity

During the stress test, if you can't exercise for as long as what's considered normal for someone your age, it may be a sign that not enough blood is flowing to your heart. But other factors besides CAD can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).

Some stress tests use a radioactive dye, sound waves, positron emission tomography (PET), or cardiac magnetic resonance imaging (MRI) to take pictures of your heart when it's working hard and when it's at rest.

These imaging stress tests can show how well blood is flowing in the different parts of your heart. They also can show how well your heart pumps blood when it beats.

Angiography

Angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your arteries. This test can show whether plaque is blocking your arteries and how severe the plaque is.

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. A dye that can be seen on x ray is then injected into the arteries. By looking at the x-ray picture, your doctor can see the flow of blood through your arteries.