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Diagnosis of Coronary Artery Disease

A cardiologist will diagnose heart disease by reviewing symptoms, medical history and risk factors. A physical exam and diagnostic tests are performed. Further testing may include an electrocardiogram or exercise stress test, blood tests or cardiac catheterization to get a closer look at arteries.

How is a Heart Attack Diagnosed?

An emergency care team will ask about symptoms and begin evaluation. Electrocardiogram results show how much damage happened to the heart muscle, and blood studies help determine the size of the heart attack. An echocardiogram after a heart attack will tell how the heart is pumping.

Physical Examination

Physical Examination for Heart & Vascular Disorders

The doctor will examine skin for good color (healthy blood flow). Pulse is checked for heart rate, rhythm and regularity. A stethoscope helps the doctor listen for murmurs (possibly a leaky valve) and clicks (stiff or narrow valves). Blood pressure determines the force of moving through the body.

Laboratory Tests

Blood Tests to Determine Risk of Coronary Artery Disease

A lab analyzes blood to identify risk for coronary artery disease. Presence of certain proteins and amino acids that can affect clotting, indicate a high-fat diet or risky habits like smoking, or be related to early development of heart disease. This information helps doctors guide treatment.

C-Reactive Protein Testing

Found in the blood, this is a marker for inflammation that can play a role in the initiation and progression of cardiovascular disease. Highly-sensitive C-reactive protein is at least as predictive of cardiac risk as cholesterol levels. A simple blood test can determine disease risk.

Enzymes & Protein Blood Tests

Damaged cells release enzymes into the bloodstream and can indicate damage to the heart. Tests measure enzyme levels and can be performed at any time of the day without fasting. In particular, levels of creatine kinase, lactate dehydrogenase and troponin T may indicate heart damage.

Lipid Blood Tests

Total cholesterol levels are directly linked to risk of heart attack and cardiovascular disease. Total cholesterol measures high-density lipoprotein (“good”), low-density lipoprotein (“bad”) and triglycerides.

Invasive Testing

Cardiac Catheterization

A long, narrow tube is inserted into a blood vessel and guided to the coronary arteries using an X-ray machine. Material is injected into blood stream so “movies” of the heart can be captured (called coronary angiography) to evaluate the situation and determine the need for further treatment.

Intravascular Ultrasound

During cardiac catheterization, a sound probe is threaded through coronary arteries. It uses high-frequency sound waves to show a detailed cross-section of the interior and layers of the artery walls.

Imaging Tests


A hand-wand waved over the chest emits high-frequency sound waves that capture a graphic outline of the heart’s movement. Images show heart valves and chambers so the heart’s pumping action can be evaluated.


This device records the electrical activity of the heart. Electrodes attached to the chest, arms and legs collect information that is charted by a computer. That information is used to diagnose blood flow to the heart, heat abnormalities and heart attack.

Exercise Stress Test

The test involves exercising on a treadmill while being closely monitored on an electrocardiograph that charts the heart’s electrical activity. The test identifies abnormal heart rhythm, evaluates a cardiac treatment plan and determines the likelihood of having coronary artery disease.

Nuclear Imaging - Heart

Radioactive tracers are injected into the vein (or taken orally or by inhalation). Then, a gamma camera takes images of the heart that give information about its functional status and viability. Doctors interpret the information and are able to detect disease at an early stage.

Radiographic Tests - Heart

These noninvasive tests use X-ray machines or specialized equipment with computer technology to create pictures of the internal structures of the chest. They give doctors a picture of the heart to evaluate.

Reviewed: 04/10

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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