How Heart Disease Is Diagnosed

The ways healthcare professionals diagnose heart disease can vary quite a bit, depending on which kind of heart disease we’re talking about. However, it is possible to outline the general method which most clinicians use to make a diagnosis when they suspect you may have heart disease. It looks like this:

1. Take a careful medical history.
2. Perform a focused physical examination.
3. Decide which medical tests are likely to help complete the diagnosis.

Medical History

“Taking a medical history” simply means that your clinician will interview you to learn what kinds of symptoms or medical complaints (if any) you may have and tease out any features associated with those symptoms that might point toward their causes.

Depending on the symptoms you describe, your healthcare professional may ask you a lot of questions detailing those symptoms—what seems to bring them on, what makes them stop, how long they last, when they have occurred, and any other associated circumstances.

Physical Examination

The cardiac examination may also give some important clues as to the presence, absence, or type of cardiovascular problem a person may have. Cardiac arrhythmias, heart valve disease, congestive heart failure, aortic aneurysm, and postural orthostatic tachycardia syndrome (POTS), are only a few of the kinds of cardiovascular problems for which the physical examination often gives very important clues, or indeed, actually confirms the diagnosis.

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Specialized Testing

A wide variety of sophisticated tests have been developed for diagnosing heart problems. While specialized cardiovascular tests are often the “gold standard” for making or confirming a cardiac diagnosis, in general they are the most useful when your healthcare professional already has a very good idea—from performing a history and physical exam—of what the correct diagnosis is.

In other words, healthcare providers should rely on the information they obtain during their initial clinical evaluation to decide what in particular to look for, which test or tests are best suited to look for it, and if more than one test is needed, which order they ought to be performed in. This way, if you have a heart problem your provider can get to the right answer as expeditiously as possible, without exposing you to unnecessary expense or risk.

Electrocardiogram (ECG)

An ECG records the electrical activity of the heart and can reveal information about the heart rhythm and important clues about structural heart disease that may be present (such as a prior heart attack, or ventricular hypertrophy.

Ambulatory Monitoring

Several systems are available that allow the recording of an electrocardiogram for days or weeks at a time, in order to record the heart rhythm over a prolonged period. These systems allow providers to diagnose cardiac arrhythmias that occur only infrequently and sporadically.

Echocardiogram or Cardiac Ultrasound

The echocardiogram study is a noninvasive test that uses sound waves to construct an image of the beating heart. Often referred to as an "echo," this study is very useful for detecting the enlargement of cardiac chambers, heart valve disease, and heart muscle problems such as dilated cardiomyopathy or restrictive cardiomyopathy.

It is a relatively quick study to perform, is noninvasive, and does not require radiation. This makes the echocardiogram a nearly ideal screening tool if structural abnormalities of the heart are suspected or if you're at high risk for heart disease but don't have any symptoms. It is also a test that can be performed repeatedly, over time, to monitor the status of a cardiac problem.

Cardiac CT Scan

A cardiac CT scan, like any CT scan, uses computerized X-ray equipment to make an image of the heart. This technique can also be used to look for calcium deposits in the coronary arteries, which is an indication that atherosclerosis is present. CT scans used to use a substantial amount of radiation, but the amount of radiation used now is significantly reduced, and may be less than the amount used for a nuclear stress test.

Cardiac MRI Study

The cardiac MRI study uses magnetic fields to construct an image of the heart and surrounding structures. This test can show impressive anatomic details, and in certain circumstances can be very useful in diagnosing and characterizing structural heart disease.

Stress Testing

Cardiac stress testing has several potential uses, but it is used chiefly to help assess whether coronary artery disease is producing cardiac ischemia that may be responsible for angina, and if so, to help assess the severity of the problem.

A stress test is often combined with a thallium scan, which uses a small dose of a radioactive material to produce an image of the heart that reflects whether the heart muscle is getting the blood flow it needs. Stress testing can also be very useful in monitoring the effectiveness of anti-anginal therapy.

Cardiac Catheterization

With this invasive test, small catheters are inserted into the blood vessels and passed into the heart and/or coronary arteries. Pressures can be measured inside the heart, and dye can be injected into blood vessels and cardiac chambers to make a moving X-ray image of blood flow.

The catheterization study has many potential applications but is used most commonly to visualize the coronary arteries in people with known or suspected coronary artery disease. Cardiac catheterization is also used to deliver therapy, most commonly, by performing angioplasty and placing stents in people with arterial blockages.

Electrophysiology Study

This is another form of cardiac catheterization, but in this case the catheters are insulated wires instead of hollow tubes. This test is used to study the cardiac electrical system to determine the presence or absence, and the mechanism, of various kinds of cardiac arrhythmias. This technique is also used to deliver ablation therapy in order to treat several kinds of arrhythmias.

Tilt Table Study

A tilt table study is performed by strapping a person to a table that has a footboard on it, then raising the table to an upright position. With certain cardiovascular conditions an upright tilt for 20 minutes or more can reproduce certain kinds of cardiovascular instability, particularly in people who are suspected of having vasovagal syncope. The tilt study can help to confirm the diagnosis.