Based on the symptoms, a Doctor would suggest few tests.
- Blood Tests : Hemoglobin level and blood counts, blood sugar levels, lipid profile, liver function tests, kidney function tests, thyroid function tests, etc.
- Urine Tests : Helps to detect kidney function, urine infection, diabetes, etc.
- Electrocardiogram (ECG) : It gives information related to heart rate and rhythm, blood supply to the heart, presence of acute or old heart attack, etc. It is very much possible that ECG can be normal in spite of heart disease or ECG may show some changes even though there is no heart disease. Thus, ECG by itself is not always the diagnostic. A Doctor may suggest additional test symptoms, signs and results of all tests to come to a diagnostic conclusion.
- Echocardiography and Color Doppler Study : This is one of the most important inventions of modern science, has done to diagnose heart diseases. In simple words, it is sonography of the heart. It gives us very valuable information about the sizes of the heart and its chambers, efficiency of the heart, structure and function of valves, blood flows within the heart and conditions of great vessels like aorta and pulmonary artery. This noninvasive test has no adverse effect like radiation. Pumping efficiency of the heart is reflected as percentage Ejection Fraction (EF). EF of 60% OR higher is considered as normal.
- Stress Test (TMT: TreadMill Test) : Many patients complain “I get chest heaviness while I exert, but not while I am at rest”. To understand how the heart behaves during stress and whether it receives during stressful situations, a cardiologist recommends stress test in which a patient is made to walk on a treadmill at an incremental speed under blood pressure, heart rate and ECG monitoring. Patients with blockage in their coronary arteries might develop chest pain after walking for a few minutes and there may be associated ECG changes also. This helps to diagnose coronary insufficiency. There are few patients who cannot walk due to associated illnesses like spine some psychiatric diseases, etc. In such patients heart rate can be artificially increased by giving slow injections of some medicine and ECG or echocardiogram or nuclear scan be recorded. These are called as Dobutamine Stress Echocardiogram or Nuclear perfusion Scan. Prior stress test, a Doctor would assess the overall fitness of the patient and his capability to walk.
- Coronary Angiography (CAG) : Arteries supplying blood to the heart are called ‘Coronary Arteries’. A photograph or film obtained after injecting a special chemical (dye) in the coronary arteries is called coronary angiography. This is the gold standard test to diagnose coronary artery disease. Patients with angina or heart attack undergo coronary angiography to determine the further path of treatment like coronary angioplasty or coronary artery bypass surgery.
This test is done under local anesthesia and the patient is fully conscious throughout. Through transradial (from wrist of the hand) or transfemoral (from the thigh) route a small caliber plastic catheter is reached near the heart under fluoroscopic (X-ray) guidance. After injecting a small volume of dye, films are taken from different angles. Blocks in the lumen of coronary arteries are depicted as percentage narrowing.
Further line of treatment is decided by an expert cardiologist after analyzing all relevant information like symptoms of the patient, results of echocardiogram and other tests, presence of other co morbidities and severity of coronary blocks.
Angiography can be done for other arteries also, like arteries supplying blood to the brain, kidneys, limbs intestines, etc.
- Coronary Angiography by CT Scan (CTCAG) : Coronary angiography can be done by 128 or 256 slice CT scan machine. This technique avoids the need of puncturing artery and taking a catheter to the heart. Intravenous injection of dye is needed. Overall accuracy of this technique is the range of 90%. This test is very useful to rule out presence of blocks in the coronary artery and certify one as free of any serious coronary blocks. Another use of CT scan is to define presence of calcium in the walls of coronary arteries. This is known as “CT calcium Score” and that is reflected in Angaston Units. Higher the Score, the more the risk of future heart attack. Thus, it helps to define the future risk and take necessary preventive steps.
- Electrophysiological study (EPS) : This test is performed under local anesthesia through groin (upper part of thigh) region to understand pattern and mechanism of heart rhythm abnormalities as well as to define the further line of treatment.