Diagnostic Tests for Angina
Diagnostic Test list for Angina: The list of diagnostic tests mentioned in various sources as used in the diagnosis of Angina includes:
- Electrocardiogram (ECG) at rest
- Stress test
- Coronary arteriogram
- Nuclear stress test
- Holter monitor - records heart rhythms; useful to diagnose variant angina.
- Cardiac catheterization
Tests and diagnosis discussion for Angina: Usually the doctor can diagnose angina by noting the symptoms and how they arise. However one or more diagnostic tests may be needed to exclude angina or to establish the severity of the underlying coronary disease. These include the electrocardiogram (ECG) at rest, the stress test, and x- rays of the coronary arteries (coronary "arteriogram" or "angiogram").
The ECG records electrical impulses of the heart. These may indicate that the heart muscle is not getting as much oxygen as it needs ("ischemia"); they may also indicate abnormalities in heart rhythm or some of the other possible abnormal features of the heart. To record the ECG, a technician positions a number of small contacts on the patient's arms, legs, and across the chest to connect them to an ECG machine.
For many patients with angina, the ECG at rest is normal. This is not surprising because the symptoms of angina occur during stress. Therefore, the functioning of the heart may be tested under stress, typically exercise. In the simplest stress test, the ECG is taken before, during, and after exercise to look for stress related abnormalities. Blood pressure is also measured during the stress test and symptoms are noted.
A more complex stress test involves picturing the blood flow pattern in the heart muscle during peak exercise and after rest. A tiny amount of a radioisotope, usually thallium, is injected into a vein at peak exercise and is taken up by normal heart muscle. A radioactivity detector and computer record the pattern of radioactivity distribution to various parts of the heart muscle. Regional differences in radioisotope concentration and in the rates at which the radioisotopes disappear are measures of unequal blood flow due to coronary artery narrowing, or due to failure of uptake in scarred heart muscle.
The most accurate way to assess the presence and severity of coronary disease is a coronary angiogram, an x-ray of the coronary artery. A long thin flexible tube (a "catheter") is threaded into an artery in the groin or forearm and advanced through the arterial system into one of the two major coronary arteries. A fluid that blocks x-rays (a "contrast medium" or "dye") is injected. X-rays of its distribution show the coronary arteries and their narrowing.1
Health care providers can usually find out if you have angina by
listening to you talk about your symptoms and their patterns. They may
also order some tests to further evaluate your angina. Tests may include
x-rays; an electrocardiogram (ECG or EKG) at rest, and during and
after exercise; a nuclear stress test; and coronary
angiography. Variant angina can be diagnosed using a Holter monitor.
Holter monitoring gets a non-stop reading of your heart rate and rhythm
over a 24-hour period (or longer). You wear a recording device (the Holter
monitor), which is connected to small metal disks called electrodes that
are placed on your chest. With certain types of monitors, you can push a
"record" button to capture a rhythm when you feel the symptoms of
1. excerpt from NHLBI, ANGINA: NHLBI
2. excerpt from Angina: NWHIC
Last revision: October 23, 2003
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