Since coronary artery disease (CAD) is usually the cause of angina, diagnosing angina really means diagnosing CAD—the underlying condition. Your doctor will do the following to either rule out or make a diagnosis of angina:
- Consider your risk factors – Age, race, sex, and weight all play a role in diagnosing angina and CAD.
- Look into your medical history – Your doctor will want to know if you or anyone in your family has a history of heart disease and diabetes. If they do, especially if it affected them early, you’re at a greater risk for angina and CAD.
- Perform a series of tests – Your doctor may suspect that you have angina based on your symptoms, but an actual diagnosis will usually be made by tests that can confirm the presence of CAD. These tests may include the following:
- Blood tests – These tests are a key diagnostic tool that your doctor will consider in conjunction with other test results and your individual risk factors, including your current health and personal and family medical histories.
- Electrocardiogram (ECG or EKG) – This test records the electrical activity in your heart. It can detect abnormalities in your heart's rhythm and certain patterns that suggest portions of the heart may not get enough blood flow.
- Chest X-ray – A chest X-ray produces an image of the inside of the chest showing the bones, heart, and blood vessels. Although it’s not as sophisticated as other diagnostic technologies, it provides information that cannot be obtained in an examination.
- Echocardiogram (echo, Doppler, or heart ultrasound) – This noninvasive test uses sound waves to create a moving picture of the heart.
- Stress test – This test can identify problems that may be more visible when your heart muscle is working harder and usually involves you walking or running on a treadmill or pedaling a stationary bicycle, followed by an imaging test to evaluate how much blood flow is getting to your heart and how effectively your heart is pumping.
- Computed Tomographic Angiography (CTA) – This noninvasive test is essentially a specialized CT scan that provides pictures of the heart's arteries.
- Conventional coronary angiogram/cardiac catheterization – In this invasive test, an interventional cardiologist threads a slender, flexible tube (catheter) into the arteries of your heart and injects an X-ray dye to be able to see inside your arteries, find any blockages, measure how severe they are, and determine what kind of treatment is needed. This test is considered the gold standard for the diagnosis of CAD. Angioplasty and stenting can be done at the same time as this test reduces any blockages.