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Tests and diagnosis
By Mayo Clinic staffAlong with a review of your medical history and a thorough physical exam, the tests and procedures used to diagnose myocardial ischemia include:
- Electrocardiogram (ECG). This test records the electrical activity of your heart via electrodes attached to your skin. Certain abnormalities in your heart's electrical activity may indicate myocardial ischemia.
- Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged. To help diagnose myocardial ischemia, your doctor may take samples of your blood to test for these enzymes.
- Echocardiogram. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn't pumping normally.
- Nuclear scan. This test helps identify blood flow problems to your heart. Small amounts of radioactive material are injected into your bloodstream. Special cameras can detect the radioactive material as it flows through your heart and lungs. Areas of reduced blood flow to the heart muscle — through which less of the radioactive material flows — appear as dark spots on the scan.
- Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. 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.
- Cardiac CT scan. CT scans can determine if you have coronary artery calcification — a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (CT coronary angiogram).
- Stress test. A stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored. Because exercise makes your heart pump harder and faster than it does during most daily activities, a stress test can reveal problems within your heart that might not be noticeable otherwise. It can be particularly useful if your doctor suspects you may have myocardial ischemia but you don't have any signs or symptoms.
- Holter monitoring. A Holter monitor is a small, wearable device that records your heart rhythm. You usually wear a Holter monitor for one to three days. During that time, the device will record all of your heartbeats. A Holter monitor test is usually performed if an electrocardiogram isn't able to give your doctor enough information about your heart's condition or if your doctor suspects silent myocardial ischemia.
References
- Deedwanla PC. Silent myocardial ischemia: Prognosis and therapy. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Deedwanla PC. Silent myocardial ischemia: Epidemiology and pathogenesis. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Goldberger AL. Electrocardiogram in the diagnosis of myocardial ischemia and infarction. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Deedwanla PC. Silent myocardial ischemia: Diagnosis and screening. http://www.uptodate.com/home/index. Accessed March 22, 2012.
- Cardiac biomarkers. American Association for Clinical Chemistry. http://www.labtestsonline.org/understanding/analytes/cardiac_biomarkers/glance.html. Accessed March 22, 2012.
- Bonow RO, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0398-6..C2009-0-59734-6--TOP&isbn=978-1-4377-0398-6&about=true&uniqId=236798031-10. Accessed March 22, 2012.
- Lanza GA, et al. Mechanisms of coronary artery spasm. Circulation. 2011;124:1774.
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