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Tests and diagnosis
By Mayo Clinic staffTo diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.
There are several tests your doctor may order to help confirm whether you have angina:
- Electrocardiogram (ECG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. An electrocardiogram — also called an ECG or EKG — records these electrical signals as they travel through your heart. Your doctor can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed or interrupted or if you are having a heart attack.
- Stress test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle. While exercising, your blood pressure is monitored and your ECG readings are watched. Other tests also may be conducted while you're undergoing stress testing. If you're unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising.
- Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
- Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. Your doctor can use these images to identify angina-related problems, including whether there are areas of your heart not getting enough blood or heart muscle that's been damaged by poor blood flow. An echocardiogram is sometimes given during a stress test.
- Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream. This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up as a light spot on the images — because not as much of the radioactive substance is getting there.
- Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization. During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.
- Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.
- Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.
References
- Angina. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_All.html. Accessed March 14, 2011.
- Angina pectoris. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4472. Accessed March 14, 2011.
- ACC/AHA management of patients with unstable angina/non-ST-elevation myocardial infarction — Pocket guideline. American College of Cardiology and the American Heart Association. http://www.americanheart.org/downloadable/heart/1194979355638UA-NSTEMI.Text.Final.pdf. Accessed March 14, 2011.
- Patient information sheet: Ranolazine. U.S. Food and Drug Administration. http://www.fda.gov/Cder/drug/InfoSheets/patient/ranolazine.pdf. Accessed March 14, 2011.
- L-arginine. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed March 11, 2011.
- Ruel M, et al. Concomitant treatment with oral L-arginine improves the efficacy of surgical angiogenesis in patients with severe diffuse coronary artery disease: The endothelial modulation in angiogenic therapy randomized controlled trial. Journal of Thoracic and Cardiovascular Surgery. 2008;135:762.
- L-carnitine. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed March 11, 2011.
- Ferrari R, et al. Therapeutic effects of l-carnitine and propionyl-l-carnitine on cardiovascular diseases: A review. Annals of the New York Academy of Sciences. 2004;1033:79.
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