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In this article:
Chest pain or discomfort may not always mean that you have angina. A
complete physical examination may help rule out other causes, including
peptic ulcer, gall bladder problems, irritation of the esophagus (the tube
between the mouth and the stomach), pneumonia, pleurisy (inflamed lung
tissue), a broken rib, or arthritis of the breastbone. Also, some types of
anxiety, such as hyperventilation (breathing too fast), panic disorder, or
depression, can bring on chest pain.
Your doctor may ask you many questions about your pain, and what seems to
trigger it or make it better or worse. Be sure to answer as completely as
possible; describe your symptoms and give examples. In turn, ask your
doctor questions about your chest pain and about the tests that your doctor
recommends. Open communication is essential for receiving the right
treatment for your illness.
Your doctor may order several tests during your checkup to make a correct
diagnosis.1
Knowing what to expect from the tests may help you understand
how your doctor decides whether you have angina.
Blood pressure and heart rate
Your doctor will probably measure your blood pressure
and heart rate. The
goal is to determine whether high blood pressure (also known as
hypertension) is causing your heart to work harder than it should.
Untreated high blood pressure can increase your chance of developing heart
disease. Your heart rate also helps your doctor determine how hard your
heart is working.
Blood tests
A blood sample analyzed in a laboratory should reveal any problems with
your blood, and also identify other conditions that may be affecting your
heart.
Anemia, for example, signals a shortage of red blood cells and/or
hemoglobin. Hemoglobin is the structure in the red blood cells that
actually carries the oxygen. A low hemoglobin count means your red blood
cells can't deliver all the oxygen your body needs to function at full
capacity.
Some illnesses can also place a higher demand on your heart. For example,
high levels of thyroid hormone (hyperthyroidism) can increase your heart
rate. Diabetes and obesity point to a higher chance of getting heart
disease. Your cholesterol and
triglyceride levels may be measured in the
blood test as well. Both are good indicators of your risk of coronary
artery disease, or CAD.
Electrocardiogram
The electrical system of the heart—the conduction system—tells the heart
when to contract, or beat. The electrocardiogram (also known as an EKG or
ECG) detects and draws the path of the electrical signals in your heart on
a moving strip of paper. These signals determine how well and at what speed
your heart is beating. More than one-half of patients with chronic angina
have a normal EKG reading when at rest. But the result of an EKG taken
while you are exercising may tell a different story. When your heart can't
keep up with the work demand, your EKG may show a certain pattern that
identifies ischemia. Ischemia means the heart isn't receiving enough oxygen
to keep working normally, and is also a sign of CAD.
Exercise tolerance testing
Exercise tolerance testing
on a patient hooked up to an EKG machine has
been used for years to help doctors diagnose angina. Your doctor may have
you exercise on a treadmill or a bicycle. The treadmill is used more than
the bicycle in the United States because people are more used to walking
than cycling.
You'll exercise in several stages, from easier to harder. Your EKG reading,
heart rate, and blood pressure are closely monitored during each stage. The
test stops when you reach a certain maximum heart rate for your age, or if
you are unable to exercise any longer. If your doctor sees that you are
having unusual changes in the speed or pattern of your heart rate or blood
pressure, the test may be stopped earlier.
Thallium stress testing
Sometimes a radioactive "tracer" called thallium is used during an exercise
tolerance test to help doctors see how well the blood is flowing through
the coronary arteries
while you are actually exercising on the treadmill or
bicycle. Thallium highlights areas of the heart that aren't getting enough
blood flow. However, some people may not be able to exercise hard enough to
do a meaningful exercise test. Others may have illnesses or abnormal heart
rhythms, or are taking medications that may make the results of the test
hard to understand. In these non-exercise stress tests, drugs are used to
increase blood flow to the heart to make it function as if it were
exercising.
Coronary angiography
Coronary angiography is your doctor's most accurate test for finding causes
of chronic angina. The procedure is usually done at a hospital in a
surgical room called the "cath lab," short for catheterization laboratory.
People with chest pain who are likely to have angina, but who can't take
exercise or stress tests because of other conditions may have angiography
instead. Others may have angiography to confirm the results of their
earlier tests.
You may be given a mild sedative beforehand. Then, a cardiologist makes a
small surgical cut (incision) in an arm or leg. Next, a catheter (a thin,
flexible tube) is inserted through the incision into an artery in your arm
or groin. The catheter is guided to the heart as the cardiologist watches
on a television monitor. When the catheter is in place, the doctor injects
a contrast dye through it into your bloodstream to see the blood flowing
through the vessels of the heart more easily, and to note any blockages in
your arteries. A fast succession of X-rays is taken of the blood flow. If
your doctor detects blockages, angina is diagnosed.
Troponin testing for heart attack
If you seek emergency help for chest pain, your pain may be caused by a
heart attack
or angina, or it may be caused by another illness. One way for
doctors to tell is by testing your blood for substances that are released
after a true heart attack. Doctors can use various tests, but the one that
they rely on the most checks for troponin.
Troponin levels go up in the blood after heart cells have been damaged,
such as during a heart attack. Doctors often test for other substances,
too, but these tests may have some limitations. For example, the levels of
some of the substances may also go up for non-heart-related reasons, making
them less reliable and specific than troponin for diagnosing a heart
attack. Because troponin testing allows doctors to diagnose heart attacks
more accurately, patients are less likely to be sent home with a missed
heart attack. On top of this, troponin testing can help spare patients from
unnecessary treatment and hospital costs if they have not had a true heart
attack.
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Source
1. "American College of Cardiology/American Heart Association/American College of Physicians/American Society of Internal Medicine Guidelines for the Management of Patients with Chronic Stable Angina." Journal of the American College of Cardiology, 1999, Vol. 33, No. 7. 2092-2197.
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