How Is Heart Disease Diagnosed?

Medically reviewed by Christopher Lee, MD

It's good practice to make an appointment with a healthcare provider or cardiologist (who specializes in the heart) for regular screenings if you have heart disease symptoms or may be at risk for heart disease. A medical history, physical exam, and blood work can help detect heart problems. The testing measures a healthcare provider will use depend on the specific type of heart disease. Most healthcare providers use a general outline for diagnosis.

Heart disease is a broad term for several conditions that affect the heart and its vessels, arteries, or valves. Coronary artery disease (CAD), or blocked arteries, is the most common type of heart disease. Other types include congestive heart failure and arrhythmias (abnormal heart rhythm), among others.

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Medical History

A healthcare provider will begin the diagnostic process with an oral medical history questionnaire or interview about your health history. They may ask you several questions, including:

• Are you taking any medications right now?

• Do you have a family history of heart disease?

• Do you have chest pain, difficulty breathing, or a heart rate that is higher than normal?

• Have you ever had heart concerns or a heart attack before?

• Have you had any recent infections, illnesses, or injuries?

• How long have you had symptoms of heart issues?

• How severe are your symptoms?

• What does your daily lifestyle look like?

• What other symptoms do you have?

Each healthcare provider is different. Some may ask you to elaborate on your symptoms in detail. Others want to get a summary of your symptoms and begin a physical exam.

Physical Exam

A physical exam is a standard part of the diagnostic process. A routine physical exam will likely include:

• Checking your body for physical symptoms (e.g., swelling, weakness, or pain)

• Listening to your heartbeat and breathing with a stethoscope

• Measuring your vital signs (e.g., heart rate, blood pressure, and temperature)

A physical exam can sometimes diagnose certain types of heart disease, such as heart failure. A healthcare provider will often order other diagnostic tests to further explain your condition, including the severity.

A physical exam can help a healthcare provider learn about your symptoms and how to move forward with testing, if necessary. Additional testing measures for heart disease can be expensive. It's important to give a healthcare provider all the information you have about your symptoms so they can calculate the exact tests you may need for a diagnosis.

Blood Tests

A healthcare provider may consider several blood tests when evaluating heart health. Blood work can detect heart problems and evaluate your risk for heart disease.

Common blood tests for heart disease may include:

• Basic metabolic panel (BMP): Measures eight substances in your blood, such as glucose, calcium, sodium, potassium, and more

• Brain natriuretic peptide (BNP) test: Checks a hormone that your heart makes

• Complete blood count (CBC): Measures counts of blood cells, plasma, and other components, along with concentrations of hemoglobin (protein that delivers oxygen to your tissues) and red blood cells (hematocrit)

• Comprehensive metabolic panel (CMP): Looks for 14 substances in your blood, such as different liver proteins like albumin

• Lipid panel: Measures cholesterol and triglycerides (a type of fat in your blood)

• Troponin test: Detects levels of a type of protein in your blood that's involved in muscle contraction

Less common blood tests may check for:

• C-reactive protein (CRP): Inflammation in your body

• Prothrombin: Protein that helps your blood clot
  

Chest X-Ray

A chest X-ray takes a photo of the organs in your chest, such as the heart and lungs. This non-invasive test checks the heart's size, shape, and location and can show if you have any fluid build-up. A radiologist (who specializes in medical imaging) will perform the chest X-ray and work with a cardiologist to understand your test results.

Invasive vs. Non-Invasive Procedures

An invasive procedure is when a healthcare provider uses medical instruments to enter or cut into the body. A non-invasive procedure does not require a healthcare provider to break into the skin to perform a test.

Electrocardiogram

An electrocardiogram, also known as an EKG or ECG, is a standard medical procedure for heart disease screenings. This non-invasive test can be done in a healthcare provider’s office, ambulance, or hospital.

An EKG examines the electrical activity of your heart and shows your heart rate and rhythm on a special kind of graph paper. The results can give a healthcare provider clues about structural damage to your heart or the possibility of a previous heart attack. An EKG can also give information about an active heart attack and abnormal heart rhythms.

A healthcare provider may want to monitor your heart rhythm more closely to ensure your heart functions normally. They may recommend a device like a Zio patch if they think you might benefit from ongoing heart rhythm evaluation. A Zio patch is an ambulatory cardiac monitor, or a small recording device that measures your heart activity for up to two weeks.

Echocardiogram

An echocardiogram (echo) is a type of ultrasound for your heart that uses sound waves to make a detailed image of your heart. This non-invasive test can check:

• How much blood is being pumped from the heart with each heartbeat

• How well your heart valves and vessels are working

• If you have a tumor or blood clot in your heart chambers

• If your heart valves are too wide or narrow

• The size, shape, and strength of your heart muscle

• The structure and motion of your heart

An echo can take up to one hour to conduct. A healthcare provider may use an echo regularly for routine appointments and screenings if you are at risk for heart disease.

Computed Tomography (CT) Scan

A computed tomography (CT) scan is a non-invasive test that uses multiple computerized X-rays to create a detailed image of the heart and blood vessels. Some CT scans can assess cardiac function. A healthcare provider will look at cardiac chamber size, valvular size and calcification (calcium build-up), and vessel sizes. A CT scan is a relatively short test and takes up to 10 minutes to complete.

The test can show:

• Fluid build-up around the heart

• Injury to the pericardium (the tissue and membrane sac that surrounds the heart)

• Plaque build-up in your arteries (vessels that carry blood from your heart to your body's cells)

• Scarring of the heart muscle

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging (MRI) creates a detailed two- or three-dimensional image of your heart using magnets and radio waves. An MRI can detect any damage to the heart, including problems with the structure, valves, and chambers. Heart disease encompasses many heart conditions. Different types of MRIs can check other organs for damage or concerns.

The most common MRIs for heart disease take pictures of the:

• Brain: Helps diagnose cerebrovascular disease (stroke caused by a blockage in the blood vessels between the heart and brain)

• Heart: Checks for changes in blood flow, blocked arteries, heart muscle tissues, and the pericardium, as well as the possibility of a heart attack

• Legs: Helps check for signs of peripheral artery disease (blockage in the blood vessels between the heart and legs)

MRIs are generally safe for most people. Let a healthcare provider know if you wear a metal device before going in for an MRI. Metal devices may include pacemakers, intrauterine devices (IUDs), and cochlear implants.

Cardiac Catheterization and Angiogram

A cardiac catheterization, sometimes known as an angiogram, is an invasive test that uses a special dye to show the shape and flow of blood in the heart's blood vessels. The test uses small catheters (thin tubes) that a healthcare provider inserts into a peripheral artery that leads to the arteries in your heart. The peripheral artery is most commonly in the wrist or groin (hip area).

A healthcare provider will then inject the special dye to help make a moving X-ray of the blood flow. This test can help identify narrow arteries or blockages in the blood flow.

Stress Test

You can complete most heart disease diagnostic measures while sitting or lying down. The stress test is different. You will most often do the stress test while exercising, such as walking on a treadmill or using a stationary bike. A healthcare provider can give you a medication that increases your heart rate and mimics the effect of exercising if exercise can strain your condition and overall health.

You can stop exercising at any point in the test if you need to. A healthcare provider may ask you to sit or lie down after the test is over. They will then check your heart rate, blood pressure, and overall fatigue.

Genetic Testing

Heart disease can be common in families. It's possible for you to inherit a heart condition from your parents or grandparents. Speak with a healthcare provider about early screening if you have lost a parent or close relative to heart disease, especially at an early age.

A healthcare provider can conduct genetic tests to examine your DNA for genes, biomarkers, or signs of inheriting a heart condition. These tests may help you understand lifestyle changes that decrease your risk of developing a heart condition.

Screening for Related Conditions

Some heart disease symptoms can overlap with other health conditions. It's also possible to have more than one kind of heart disease at the same time. A healthcare provider may recommend additional testing to rule out other conditions and confirm a diagnosis.

Chest pain, a classic sign of a heart condition, can also appear because of stomach, muscle, or breathing problems. Shortness of breath is common in heart conditions, but problems with the lungs, liver, and kidneys can also cause it.

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A Quick Review

Heart disease is the leading cause of death worldwide. Symptoms of heart disease can sometimes go unnoticed. That's why annual physical screening visits to a healthcare provider are so important.

It's good practice to get tested if you think you may be at risk for heart disease or have symptoms. Several heart conditions fall under the heart disease umbrella. A healthcare provider will first take your medical history and perform a physical exam before deciding what testing measures are appropriate for your symptoms.

A healthcare provider may order one or more tests to check your heart health. Some tests are simple and noninvasive, while others use more advanced technology and invasive procedures. The important thing is that the tests will give you a better understanding of your health. Getting tested for heart disease can be scary. Keep in mind that an early diagnosis gets you started on treatments sooner, which can lead to a healthier and longer life.

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