Coronary Heart Disease Diagnosis

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Your healthcare provider will diagnose coronary heart disease based on your symptoms, your medical and family history, your risk factors, and the results from tests and procedures.

Heart disease can be a silent condition, meaning you may not have any symptoms until you have a serious health problem, such as a heart attack or cardiac arrest. Having regular checkups is important to help your healthcare provider know your risk and recommend healthy lifestyle changes to prevent heart disease.

You should start getting screening tests and risk assessments for coronary heart disease around age 20 if you do not have any risk factors for it. Children may need screening if they have risk factors, such as obesity, low levels of physical activity, or a family history of heart problems.

Your provider may recommend preventive treatments such as heart-healthy lifestyle changes to help you lower your risk of coronary heart disease.

To screen for coronary heart disease, your provider may:

• Assess your risk factors to help evaluate your chances of developing coronary heart disease
• Calculate your body mass index and waist circumference to help determine whether you have overweight or obesity 
• Check your blood pressure to see whether you have high blood pressure, also called hypertension
• Order blood tests to see whether you have high blood cholesterol, high blood triglycerides, or diabetes

Screening usually happens in a provider’s office, but sometimes screenings are done at health fairs, drugstores, or other places. Blood samples might be collected at the provider’s office, a hospital, or a laboratory.

Ask whether you need to fast (not eat or drink anything besides water) before the blood tests.

If you have symptoms or a family history of coronary heart disease, your healthcare provider may order tests and procedures.

Your provider will likely run some blood tests to check the levels of cholesterol,  triglycerides ,  lipoproteins , sugar, or proteins that are a sign of  inflammation .

To help diagnose coronary heart disease, your provider may also order some of the following heart tests and procedures:

• An electrocardiogram (ECG or EKG) records the strength and timing of electrical signals as they pass through the heart and determines whether the heart’s rhythm is steady or irregular. 
• A coronary calcium scan measures the amount of calcium in the walls of your coronary arteries. This test is a type of cardiac computed tomography (CT) scan. Coronary calcium scans can also help assess coronary heart disease risk for people who smoke or who do not have heart disease symptoms.
• Stress tests check how your heart works during physical activity or in response to a medication. During stress testing, you walk or run on a treadmill or pedal a stationary bike to make your heart work hard and beat quickly. If you have a medical problem that prevents you from exercising, your provider may give you medicine to make your heart work harder, as it would during exercise. To check for low blood flow to your heart muscle, your provider will use an ECG, echocardiogram, or another imaging test to monitor you while you exercise.
• Cardiac magnetic resonance imaging (MRI) detects tissue damage or problems with blood flow in the heart or coronary arteries. It can help your provider diagnose coronary microvascular disease, as well as nonobstructive or obstructive coronary artery disease. A cardiac MRI can also help explain results from other imaging tests.
• A cardiac positron emission tomography (PET) scan assesses blood flow through the coronary blood vessels and into the heart muscle. This type of nuclear imaging test can help diagnose coronary microvascular disease.
• Invasive coronary angiography uses contrast dye to detect blockages in the coronary arteries. Your provider will insert the dye into your coronary arteries in a procedure called cardiac catheterization. This procedure is often used if other tests show that you are likely to have coronary artery disease. 
• Coronary CT angiography is a less invasive imaging test that looks at blood flow through the coronary arteries, using a specialized X-ray machine that takes multiple pictures of the heart.

Your healthcare provider may use a risk calculator to estimate your chances of having a heart attack, having a stroke, or dying from heart disease in the next 10 years or more.

For example, the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator Plus considers your  cholesterol  levels, age, sex, race, and blood pressure to assess your risk for heart disease or a heart-related event. It also factors in whether you smoke or take medicines to manage your high blood pressure or blood cholesterol.

Ask about your risk during your annual checkup. Understanding your risk will help you and your provider to decide on healthy lifestyle changes, and possibly medicines, to help prevent heart disease.

Risk assessments should be repeated every 4 to 6 years in adults 20 to 79 years of age who do not have heart disease.

No single risk calculator is appropriate for all people. Calculators can give you and your healthcare provider a good idea about your risk, but your provider may consider other factors to estimate your risk more accurately.

Common risk calculators might not accurately estimate risk in certain situations. These estimators may not account for:

• Complications during pregnancy or early menopause
• Metabolic syndrome or an inflammatory or autoimmune condition
• Family history of heart or blood vessel disease at a young age
• The use of statins to manage cholesterol levels

In these cases, your healthcare provider may suggest other tests for coronary heart disease even if the ASCVD Risk Estimator Plus or other calculator says you are not at high risk.