How to Detect Coronary Artery Disease

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Tests commonly used to diagnose CAD include electrocardiography, echocardiography, exercise stress testing, coronary angiography, and radionuclide imaging.

Electrocardiography

The electrocardiogram (ECG), which reflects the heart's electrical activity, can detect signs of ischemia, injury, and infarction as well as abnormalities in heart rate and rhythm. However, it doesn't always detect ischemia, injury, and infarction. For example, a patient who has had a transmural MI (an infarction that extends through the entire myocardial wall) usually has a characteristic abnormal Q wave on her ECG. But if the MI only extends through the subendocardial layer, the remaining healthy tissue can still conduct electrical impulses, and an abnormal Q wave won't appear on the ECG. In general, patients with diabetes are more likely to have this type of an MI.

Echocardiography

An echocardiogram, which records ultrasonic waves reflected off the heart, evaluates the heart's size, shape, and motion. This test can detect changes caused by CAD, such as an increase in the mass of the left ventricular wall, which is more common in patients with diabetes and may by worsened by hypertension. In this way, it identifies patients who are at risk for other cardiac problems, such as an MI and heart failure.

Exercise Stress Test

Exercise stress testing is a variation of the standard ECG. During this test, the patient's heart rate, heart rhythm, and blood pressure are monitored while she rides a stationary bicycle, walks on a treadmill, or climbs stairs. As the patient's activity level increases, her ECG tracing may show changes if her myocardium doesn't receive enough oxygen and nutrients.

If your patient has CAD or is suspected of having it, exercise stress testing can assess the effects of physical stress on her heart. If she is recovering from an Ml or coronary artery bypass surgery, this test can also help predict her response to rehabilitation.
Coronary Angiography

A radiographic test, coronary angiography is used to detect coronary artery stenosis or occlusion and to assess the condition of blood vessels beyond the occlusion. In some cases, angiography may be used to guide coronary angioplasty or atherectomy, which may be performed to remove the occlusion. However, angiography should only be used in patients for whom the test will provide vital diagnostic data because its radiographic contrast medium can cause renal impairment, especially in patients who already have nephropathy.
Radionuclide Imaging

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