The evaluation of coronary artery disease begins with a medical history and physical examination.

Physical findings in someone with coronary artery disease may include:

• Congested lungs:
• Rales on auscultation of the lung fields
• Creased ear lobe
• Excessive sweating
• Heart murmur
• High blood pressure
• Low blood pressure
• Irregular heartbeat
• Rapid pulse
• Swelling of the legs and feet
• Swelling of the veins in the neck
• Xanthelasma

• Cardiac enzymes
• CPK-MB fraction
• Troponin level
• Myoglobin level
• C-reactive protein
• Cholesterol level
• Triglyceride level

• Chest x-ray:
• Normal chest x-ray
• Heart failure x-ray
• EKG
• Exercise stress test
• Cardiac catheterization
• Echocardiogram
• Intracoronary ultrasound:
• Shows images of the inside of coronary arteries
• MRI scan of the heart:
• Shows detailed images of the heart and coronary arteries
• Detects structural abnormalities of the heart
• MUGA scan
• SPECT scanning of the heart:
• Detects blood flow abnormalities to heart muscle
• Thallium heart scan
• Coronary artery CT scanning:
• Checks for possible obstructions in the coronary arteries
• Can show a build-up of calcium in a coronary artery
• Rubidium PET/CT scanning of the heart:
• Combines positron emission tomography or PET scanning with CT angiography
• Obtains information about the heart's anatomy and function in a single test

• Angina evaluation
• Heart attack evaluation
• Acute coronary syndrome evaluation

An electrocardiogram or ECG can be an effective tool in detecting coronary artery disease.

How an ECG Works
An electrical impulse stimulates the muscle fibers in the heart to contract. The impulse spreads through the heart in a very organized manner. The heart's normal electrical impulse has a characteristic pattern. The EKG machine displays the pattern of the electrical impulse.

Abnormal electrical patterns on the EKG can help identify heart disease.

The EKG can identify:

• Heart injury:
• Consistent with low oxygen to the heart
• Damage due to heart attack
• Enlargement of the heart
• Cardiac arrhythmia:
• Abnormal heartbeats or rhythms
• Abnormal electrical activity in the heart

Cardiac catheterization and coronary angiogram are effective tools for detecting coronary artery disease.

How Heart Catheterization Works
During a cardiac catheterization, a catheter (thin plastic tube) is inserted into an artery in the groin, and then threaded up through the aorta to the heart. The catheter can be used to inject x-ray dye into the coronary arteries that supply the heart. An x-ray machine is used to take pictures of the dye inside the coronary arteries. This procedure is referred to as coronary angiography. Using these procedures doctors can detecting narrowing or obstruction of the coronary arteries.

Examples include:

• Cardiac catheterization
• Coronary angiogram
• Coronary angiograms

Thallium stress testing is an effective tool for detecting coronary artery disease.

How Thallium Stress Testing Works
The thallium stress test identifies areas of the heart muscle that receive reduced blood flow from narrowed or blocked coronary arteries. During the test, thallium is injected into the bloodstream. Heart muscle cells collect the thallium in the bloodstream. If blood flow is reduced through one of the coronary arteries, then the muscle cells that are supplied by that artery do not collect as much thallium as muscle cells that receive normal blood flow. A special camera is used to detect thallium in the heart muscle and a computer constructs images of the heart. The images show areas that receive reduced blood flow.

Examples:

• Thallium stress test
• Gamma camera measures radiation given off by the thallium
• Thallium heart scan image

Last Updated: Dec 8, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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