What Tests Are Used to Diagnose Heart Problems?

Because there are many types of cardiac disease, each affecting different parts and functions of the cardiovascular system, we need a battery of heart tests to make an accurate diagnosis. Some tests, such as an echocardiogram, are used to identify abnormalities within the heart or blood vessels. Others, such as stress testing, aim to see how well the organs are performing with respect to your age, health, and personal characteristics.

Overall Heart Health

The tests below are commonly used when there is a suspicion of cardiovascular disease. They are typically used to establish a baseline in people with no known cardiac disease. Over time—sometimes weeks, sometimes years—the tests can be repeated to see if there is any deterioration or improvement from the baseline function.

Some of the routine procedures include:

• Electrocardiogram (ECG): A test that measures the electrical activity of your heart and the rhythm and strength of your heartbeat
• Echocardiogram: A form of ultrasound that uses sound waves to create pictures of your heart's chambers, valves, walls, and blood vessels
• Stress testing: Also known as stress ECG; lets your healthcare provider know how well your heart responds to activity as you walk at a moderate pace on a treadmill.

Coronary Artery Disease

These tests are commonly ordered when healthcare providers are suspicious of coronary artery disease (CAD). They are typically performed alongside an ECG and stress test to investigate the possible causes.

Certain patterns on an ECG, for example, indicate a myocardial infarction (heart attack). Similarly, stress tests can be used to help diagnose angina.

When used in conjunction with other diagnostic tests, these technologies can help support a diagnosis and direct the course of treatment. Among them are:

• Nuclear stress testing: Uses a radioactive tracer injected into the blood to evaluate the blood flow through the heart and circulatory system
• MUGA scans: Also uses a radioactive tracer to take pictures of your heart as it pumps blood with every heartbeat
• Calcium scans: Uses a special X-ray technique called a computed tomography (CT) scan to check for the buildup of calcium in the plaque of arterial walls
• Cardiac MRI: Also known as magnetic resonance imaging; uses magnetic waves to create pictures of your heart from many angles
• Cardiac catheterization and angiography: Involves the insertion of a thin, flexible tube called a catheter into an artery of the leg or arm that is fed to the arteries in the heart. During angiography, a dye is injected through the catheter to create X-ray images of the surrounding blood vessels.

Heart Rhythm Problems

These tests are commonly used to detect and diagnose heart rhythm disturbances known as arrhythmia. They can also be used to help determine the cause of syncope (fainting). Among them are:

• Holter monitoring: Also known as event monitoring, this is a small portable ECG device that can be worn by the patient to monitor the heartbeat for 24 to 48 hours. An extended Holter is generally worn for 3 to 14 days. An event monitor is typically worn for 14 to 30 days.
• Electrophysiology study: Also known as an EP study, this is a minimally invasive procedure. During an EP study, a catheter is placed into a blood vessel. The catheter is maneuvered into different areas of the heart and records the heart's electrical activity.
• Tilt table testing: During a tilt table test, you lay flat on the table and progressively tilted to an almost upright position. Additionally, medications may be administered.
• Transesophageal echocardiogram: A means of obtaining clearer images of the heart structure by inserting a flexible ultrasound into the esophagus (feeding tube)