heart and blood vessel disorders
Angina
Diagnosis of Angina
Electrocardiography Doctors diagnose angina largely based on a person’s description of the symptoms. A physical examination and Electrocardiography (ECG) may detect little, if anything, abnormal between and sometimes even during attacks of angina, even in people with extensive coronary artery disease. During an angina attack, the heart rate may increase slightly, blood pressure may go up, and with a stethoscope, doctors may hear a change in the heartbeat. ECG may detect changes in the heart’s electrical activity. When symptoms are typical, the diagnosis is usually easy for doctors to make. The kind of pain, its location, and its association with exertion, meals, weather, and other factors help doctors make the diagnosis. The presence of risk factors for coronary artery disease also helps establish the diagnosis. Doctors may do other procedures to evaluate the blood supply to the heart muscle and determine whether coronary artery disease is present and how extensive it is. Stress Testing (also called exercise tolerance testing) is based on the principle that if the coronary arteries are only partly blocked, the heart may have an adequate blood supply when the person is resting but not when the heart is working hard. For stress testing, the person's heart is made to work hard by exercise (for example, walking on a treadmill or riding a stationary bicycle). People who cannot do such exercise may be given stimulant drugs that make the heart beat faster. During the stress test, the person is monitored by ECG to look for abnormalities that suggest ischemia. After the stress, doctors often do more accurate but more expensive tests, such as echocardiography and Radionuclide Imaging of the Heart to look for areas of the heart that are not receiving enough blood. These procedures can help doctors determine whether coronary angiography or coronary artery bypass grafting (CABG) is needed. During an exercise tolerance (stress) test, the person walks at an increasingly rapid pace on a treadmill. The person wears a blood pressure cuff (the black arm band), which monitors blood pressure throughout the procedure. A video monitor displays the pulse and ECG. The results help determine the presence of coronary artery disease. Video from Video Tape Library, Ltd. Echocardiography and Other Ultrasound Procedures uses ultrasound waves to produce images of the heart (echocardiograms). This procedure shows heart size, movement of the heart muscle, blood flow through the heart valves, and valve function. Echocardiography is done during rest and exercise. When ischemia is present, the pumping motion of the left ventricle is abnormal. For Magnetic Resonance Imaging (MRI) of the Heart , x-rays of arteries are taken after a radiopaque contrast agent is injected. Coronary angiography, the most accurate procedure for diagnosing coronary artery disease, may be done when a diagnosis is uncertain. Coronary angiography is commonly used to help evaluate whether In a few people who have typical symptoms of angina and abnormal results on a stress test, coronary angiography does not confirm the presence of coronary artery disease. Some of these people have microvascular angina, but for most, the source of the symptoms does not involve the heart. Continuous ECG monitoring with a Continuous Ambulatory Electrocardiography may detect abnormalities indicating symptomatic or silent ischemia or variant angina (which typically occurs during rest). Computed Tomography (CT) of the Heart None Computed Tomography (CT) of the Heart None Magnetic Resonance Imaging (MRI) of the Heart None 