How Is Angina Diagnosed?
The most important issues to address when you go to
the doctor with chest pain are:
- What's causing the chest pain
- Whether you're having or are about to have a
heart
attack
Angina is a symptom of an underlying heart problem,
usually
coronary
artery disease (CAD). The type of angina pain you have can be a sign of how
severe the CAD is and whether it's likely to cause a heart attack.
If you have chest pain, your doctor will want to
find out whether it's angina. He or she also will want to know whether the
angina is stable or unstable. If it's unstable, you may need emergency medical
attention to try to prevent a heart attack.
To diagnose chest pain as stable or unstable angina,
your doctor will do a physical exam, ask about your symptoms, and ask about
your risk factors and your family history of CAD or other heart disease.
He or she may also ask questions about your
symptoms, such as:
- What brings on the pain or discomfort and what
relieves it?
- What does the pain or discomfort feel like (for
example, heaviness or tightness)?
- How often does the pain occur?
- Where do you feel the pain or discomfort?
- How severe is the pain or discomfort?
- How long does the pain or discomfort last?
Diagnostic Tests and Procedures
If your doctor suspects that you have unstable
angina or that your angina is related to a serious heart condition, he or she
may order one or more tests.
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.
However, some people with angina have a normal EKG.
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.
During exercise stress testing, your blood pressure
and EKG readings are checked while you walk or run on a treadmill or pedal a
bicycle. Other heart tests, such as
nuclear
heart scanning or
echocardiography,
also can be done at the same time.
If you're unable to exercise, a medicine can be
injected into your bloodstream to make your heart work hard and beat fast.
Nuclear heart scanning or echocardiography is then usually done.
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
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, as well as lung disorders and other causes of symptoms that aren't
due to CAD.
Coronary Angiography and Cardiac
Catheterization
Your doctor may ask you to have
coronary
angiography (an-jee-OG-ra-fee) if other tests or factors show that you're
likely to have CAD. This test uses dye and special x rays to show the insides
of your coronary arteries.
To get the dye into your coronary arteries, your
doctor will use a procedure called
cardiac
catheterization (KATH-e-ter-i-ZA-shun). A long, thin, flexible tube called
a catheter is put into a blood vessel in your arm, groin (upper thigh), or
neck. The tube is then threaded into your coronary arteries, and the dye is
released into your bloodstream. Special x rays are taken while the dye is
flowing through the coronary arteries.
Cardiac catheterization is usually done in a
hospital. You're awake during the procedure. It usually causes little to no
pain, although you may feel some soreness in the blood vessel where your doctor
put the catheter.
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 CAD.
Your doctor may order a blood test to check the
level of C-reactive protein (CRP) in your blood. Some studies suggest that high
levels of CRP in the blood may increase the risk for CAD and heart attack.
Your doctor also may order a blood test to check for
low hemoglobin (HEE-muh-glow-bin) in your blood. Hemoglobin is an iron-rich
protein in the red blood cells that carries oxygen from the lungs to all parts
of your body. If you have low hemoglobin, you may have a condition called
anemia
(uh-NEE-me-eh). |