Diagnosis of angina pectoris

How Is an Angina Diagnosis Made?

In order to diagnose angina, your healthcare provider will ask a number of questions, including questions about:

· Current symptoms

· Other medical conditions

· Current medications

· Risk factors for angina and coronaryheart disease

· Family history of medical conditions, including heart disease.

Your healthcare provider will also perform a physical exam, looking for signs andsymptoms of angina, and recommend certain tests and/or procedures. These procedures are used to:

· Decide if you have angina

· Determine the extent and severity of the disease

· Rule out other possible causes of your symptoms.

Tests Used to Diagnose Angina

Some of the tests your healthcare provider may recommend to help make an angina diagnosis include:

· Blood tests

· Electrocardiogram (ECG or EKG)

· Stress tests

· Echocardiogram

· Nuclear heart scans

· Cardiac catheterization

· Other tests.

Your doctor uses your physical exam results, your risk factors, family history, and your symptoms to decide which test or tests to order.

Blood Tests

Some blood tests that may be ordered as part of evaluating someone for angina include:

· A fasting glucose test to check your blood sugar level.

· A fasting lipid panel to check yourcholesterol and triglyceride levels.

· The CRP test measures c-reactive protein (CRP), a protein in the blood that shows the presence of inflammation. Inflammation is the body's response to injury. High levels may be a risk factor for heart disease (see CRP Test for Heart Disease).

· A test to check for low hemoglobin in your blood. Hemoglobin is the part of red blood cells that carries oxygen to all parts of your body. Low hemoglobin can worsen angina in people at risk for it.

Electrocardiogram

An electrocardiogram (ECG or EKG) is a test that records your heart's electrical activity and can show certain problems, such as abnormal heartbeats or damage to the heart.

Stress Tests

Some heart problems are easier to diagnose when the heart is working hard and beating fast. During stress testing, a patient exercises or is given medicine to make the heart work harder and beat faster while tests are performed.

An exercise stress test is where your heart, breathing, and blood pressure are monitored while you exercise using a treadmill or a stationary bicycle. An EKG is usually done before, during, and after the stress test.

Other heart tests, such as nuclear heart scanning or echocardiography, can be done at the same time as an EKG. During nuclear heart scanning, radioactive dye is injected into the bloodstream, and a special camera shows the flow of blood to the heart muscle. If a person is unable to exercise, a medicine can be injected into the bloodstream to make the heart work harder and beat faster. Nuclear heart scanning or echocardiography is then done.

Two newer tests that are being done with stress testing are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of the heart. PET scanning shows blood flow to the heart muscle and areas of damage.

Echocardiogram

An echocardiogram is an exam of the heart using sound waves. This test may be done while the person is at rest or exercising (called an exercise stress echocardiogram).

Nuclear Heart Scan

A nuclear heart scan (also known as a thallium stress test) shows areas of the heart that lack blood flow and are damaged. It can also reveal problems with the heart's pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records whether the nuclear material is taken up by the heart muscle (these are healthy areas) or not (these are damaged areas).

The camera can also evaluate how well the heart muscle pumps blood. A nuclear heart scan can be done during both rest and exercise, enhancing the usefulness of its results.

Cardiac Catheterization

Cardiac catheterization, also known as coronary angiography or coronary arteriography, is a computerized x-ray of the coronary arteries. A catheter (a thin plastic tube) is inserted into an artery in the groin or arm and threaded into a coronary artery. After a fluid is injected, the x-ray reveals blockages in the coronary arteries.

Is the Diagnosis Angina or Another Medical Condition?

Several other medical conditions can cause chest pain. It is important to keep in mind that chest pain is not always caused by a problem in the heart. Your healthcare provider will consider other possible conditions before making an angina diagnosis. Some of these other conditions include:

· Heartburn

· Gastroesophageal reflux disease (GERD)

· Peptic ulcer, which is an ulcer in the stomach or first part of the intestines

· Arthritis of the shoulder or spine

· Cervical disk disease

· Herpes zoster

· Aortic stenosis

· Pericarditis, which is inflammation of the thin layer of tissue that surrounds the heart

· Pneumonia

· Pulmonary embolism

· Anxiety.