How to Check for Coronary Heart Disease

Diagnosing coronary heart disease (CHD) involves a comprehensive evaluation that combines patient symptoms, medical history, and various diagnostic tests. These tests may include electrocardiogram (ECG), stress ECG, echocardiogram, non-invasive vascular imaging techniques such as coronary computed tomography angiography (CTA), coronary angiography, and nuclear imaging studies.

Understanding Symptoms and Risk Factors

The first step in assessing CHD is to identify whether the patient experiences symptoms of myocardial ischemia, such as exertional angina. It's also essential to evaluate the presence of high-risk factors associated with coronary artery disease. These risk factors include a family history of heart disease, smoking, excessive alcohol consumption, hypertension, high cholesterol levels, and diabetes.

Initial Diagnostic Tests

Electrocardiogram (ECG)

An ECG is often one of the first tests performed. It helps detect any regional changes in the ST segment, which can indicate heart muscle stress or damage. This test provides a baseline assessment of the heart's electrical activity.

Stress Test (Exercise ECG)

A stress test evaluates how the heart performs under physical exertion. During this test, the patient typically walks on a treadmill or pedals a stationary bike while heart function is monitored. This can reveal ischemic changes that are not apparent at rest.

Imaging and Blood Flow Assessment

Echocardiogram

An echocardiogram uses sound waves to create images of the heart. It allows doctors to observe the movement of the heart walls and identify any regional abnormalities that may suggest ischemia or reduced blood flow.

Nuclear Imaging (ECT)

Emission computed tomography (ECT), or nuclear stress testing, provides detailed images of blood flow to the heart muscle. This technique helps determine whether the heart is receiving adequate blood supply during rest and stress conditions.

Advanced Diagnostic Techniques

Coronary CTA and Angiography

For a more definitive diagnosis, coronary CTA or invasive coronary angiography may be performed. These procedures use contrast dye and imaging technology to visualize the coronary arteries and detect any narrowing or blockages. Coronary angiography, in particular, is considered the gold standard for diagnosing coronary artery disease due to its accuracy and clarity in showing the extent of arterial damage.