How is Coronary Artery Disease (CAD) Diagnosed?
Your cardiologist (heart doctor) can tell if you have coronary artery disease by
- talking to you about your symptoms, medical history, and risk factors
- performing a physical exam
- performing diagnostic tests
Diagnostic tests help your doctor evaluate the extent of your coronary heart disease, its effect on the function of your heart, and the best form of treatment for you. They may include:
- Electrocardiograph tests, such as an electrocardiogram (ECG or EKG) or exercise stress tests, use the electrocardiogram to evaluate the electrical activity generated by the heart at rest and with activity.
- Laboratory Tests: include a number of blood tests used to diagnose and monitor treatment for heart disease.
- Invasive Testing, such as cardiac catheterization, involve inserting catheters into the blood vessels of the heart in order to get a closer look at the coronary arteries.
Other diagnostic tests may include:
- Nuclear Imagingproduces images by detecting radiation from different parts of the body after the administration of a radioactive tracer material.
- Ultrasound Tests, such as echocardiogram use ultrasound, or high frequency sound wave, to create graphic images of the heart's structures, pumping action, and direction of blood flow.
- Radiographic Testsuse x-ray machines or very high tech machines (CT, MRI) to create pictures of the internal structures of the chest.
Tests used to predict increased risk for coronary artery disease include: C-reactive protein (CRP), complete lipid profile and calcium score screening heart scan.
What are the risk factors for coronary artery disease?
Nonmodifiable risk factors (those that cannot be changed) include:
- Male gender. Men have a greater risk of heart attack than women do, and men have heart attacks earlier in life than women. However, beginning at Age 70, the risk is equal for men and women.
- Advanced age. Coronary artery disease is more likely to occur as you get older, especially after Age 65.
- Family history of heart disease. You have an increased risk of developing heart disease if you have a parent with a history of heart disease, especially if they were diagnosed before Age 50. Ask your doctor when it's appropriate for you to start screenings for heart disease so it can be detected and treated early.
- Race. African Americans have more severe high blood pressure than Caucasians and, therefore, have a higher risk of heart disease. The risk of heart disease is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes in these populations.
Modifiable risk factors (those you can treat or control) include:
- Cigarette smoking and exposure to tobacco smoke
- High blood cholesterol and high triglycerides – especially high LDL ("bad") cholesterol over 100 mg/dL and low HDL ("good") cholesterol under 40 mg/dL. Some patients who have existing heart or blood vessel disease, and other patients who have a very high risk, should aim for a LDL level less than 70 mg/dL. Your doctor can provide specific guidelines.
- High blood pressure (140/90 mmHg or higher)
- Uncontrolled diabetes (HbA1c >7.0)
- Physical inactivity
- Being overweight (body mass index [BMI] 25–29 kg/m2) or being obese (BMI higher than 30 kg/m2)
- NOTE: How your weight is distributed is important. Your waist measurement is one way to determine fat distribution. Your waist circumference is the measurement of your waist, just above your navel. The risk of cardiovascular disease increases with a waist measurement of over 35 inches in women and over 40 inches in men.
- Uncontrolled stress or anger
- Unhealthy Diet
The more risk factors you have, the greater your risk of developing coronary artery disease.