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Ischemic or Coronary heart disease (Diagnosis)

This post is also available in: हिन्दी (Hindi)

How to diagnose coronary artery disease?

CAD/IHD is diagnosed in following manner:

History: the doctors starts with asking your symptoms, personal and family history, where focus is made on checking for the presence of risk factors.

Clinical examination: Doctors checks the vitals including BP, heart rate and does basic general and cardiac examination including listening to the heart sounds.

After this doctor may ask for some basic tests are also done like blood tests and ECG. The doctors go for specialized tests, if there are any or obvious symptoms or risk factors, or if the basic tests show some positive results.

The tests done are as follows:

• Blood tests: to check for levels of cholesterol, triglycerides, LDL, HDL, glucose in the blood. Some cardiac markers like cTn (cardiac troponin) and CK-MB (creatine kinase MB) these are substances released in blood after heart attack.

• Electrocardiogram (ECG): it assess the electrical activity in the heart and thus helps to understand its basic functioning. It may give evidence of previous heart attack or may suggest an ongoing one.
Imaging tests:

Echocardiography (Echo): is similar to how ultrasound works. It shows various parts of the hearts and their functioning like walls, chambers, valves and major vessels. It also shows how blood is being pumped and allow to measure the capacity of the heart to pump the blood.
It shows if all the parts are moving in coordination to allow normal pumping or not. If it shows that a part is moving less or not moving at all then it may indicate that it is either receiving less blood or damaged due to heart attack.

Stress tests: is done to check how the heart works under stress. The stress can be given by asking the person to walk or run on treadmill or do cycling. If a person is unable to do physical activity the stress can be given by medicines. During or after giving stress, few tests like ECG or echocardiography can be done to check the hearts ability to work under stress. This may unmask the problems of the heart which might not be obvious under rest.

Sometimes MRI may also be done under stress using medicines.

• CT angiography and calcium scoring: both the tests uses X-rays released from the CT machine to develop images of coronary arteries. CT calcium scoring detects and measures the amount of calcium in the coronary arteries which in turn indicates coronary artery disease.

• CT angiography tests also uses dye which fills up the coronary arteries allowing detailed visualization of the arteries. It shows the amount of narrowing/blockage, location of the blockage and type of the blockage.
This test less crude and invasive than the conventional catheter angiography where catheter is inserted unto the heart.

• Cardiac MRI: can detect any abnormality with the blood flow in the heart or coronary arteries or any damage to the various parts of heart. It can helpful to diagnoses some difficult cases where other tests falls short.

Cardiac PET: injects some liquid in the body which emits radiation. These radiations are picked up by the PET machine which forms images of the heart. It can show reduced blood flow to different parts of the heart diagnosing coronary artery disease. It can also detect damaged portion of the heart. This test is also done after stress and under rest.

Conventional coronary angiography: this test allows visualization of the coronary arteries, the amount of narrowing/blockage and location of the blockage. The flip side of this test is that it needs a specialized tube called catheter to be inserted into the body which is then passed upto the coronary artery. This makes it more invasive test. However, the unique benefit of this test is that, the same procedure can be extended to treat the coronary artery narrowing using angioplasty and stenting.

This is a widely used procedure in patients presenting to emergency or with typical symptoms of heart attack.

Tests to diagnose small vessel disease of heart:

• Coronary guidewire sensor technology

• Trans thoracic doppler ultrasound

• Cardiac PET

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