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 of heart tests. Your provider will likely screen you for coronary heart disease at your regular checkups. Providers may use an app to assess your chance of developing heart disease in the next 10 years or beyond.

You may not have any symptoms until you have a serious health problem, such as a heart attack or cardiac arrest. Regular checkups allow you to talk with your healthcare provider about your risk and how to prevent heart disease. Heart-healthy lifestyle changes can also help.

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

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 offered at health fairs, drugstores, or other places. Blood samples might be collected at a provider’s office, hospital, or laboratory. Ask whether you need to fast (not eat or drink anything besides water) before the blood tests.

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

Risk assessments should be repeated every four to six years in adults who do not have heart disease.

Risk calculators can give you and your healthcare provider good information about your risk. But your provider may consider other factors to estimate your risk more accurately. There are several different risk calculators, and no single risk calculator is right for everyone. 

• The Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator Plus app uses your cholesterol levels, age, sex, race, and blood pressure to assess risk. It also considers whether you smoke or take medicines to manage your high blood pressure or blood cholesterol. The app is for people between ages 20 and 79 who have not had a heart problem. For details on the app, read pages eight and nine in our booklet, Your Guide to Lowering Your Cholesterol with Therapeutic Lifestyle Changes (TLC).
• The American Heart Association’s PREVENT^TM app is based on data from a diverse group of 6 million people. The app does not consider race, but it includes social factors based on ZIP codes to help predict the risk of heart problems. This tool is for adults between ages 30 and 79.

Ask about your risk during your annual checkup. Understanding your risk will help you and your provider decide on healthy lifestyle changes, and possibly medicines, to help prevent coronary heart disease. Your provider may suggest other tests for the disease even if your risk score is not high.

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 your 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:

• An electrocardiogram (ECG) 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 your heart while it is working hard and beating quickly. For stress testing, you walk or run on a treadmill or pedal a stationary bike. If you have a medical problem that prevents you from exercising, your provider may give you medicine to make your heart work harder for a short time. To check for low blood flow to your heart muscle, your provider will use an ECG or another imaging test. An ECG will monitor your heart's electrical activity 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 disease in the small coronary arteries, known as 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.
• Coronary CT angiography is an imaging test that looks at blood flow through the coronary arteries using a special X-ray machine that takes multiple pictures of the heart.
• Invasive coronary angiography uses contrast dye to detect blockages in the coronary arteries. Your provider will inject the dye into your coronary arteries using cardiac catheterization. This procedure is often used if other tests show that you are likely to have coronary artery disease.

Your test results may show how much plaque is clogging your coronary arteries.

FACT SHEET

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