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From the patient’s description of symptoms, a physician can usually determine whether angina is present during a physical examination. Words used to describe angina include tightness, squeezing, crushing, burning, choking or aching. Because angina is not specific in location, patients may not be able to tell exactly where it comes from. Instead, they may make a fist in the middle of their chest to demonstrate chest pain. This is called a Levine sign and may cause the physician to suspect angina.
During an angina attack, a physician will assess a patient’s heartbeat, heart rate and blood pressure, which can be elevated. Various blood tests and/or a urine test may be ordered. From there, additional tests may be performed to determine the underlying cause of the angina, as well as the extent of any heart damage and coronary artery disease. These include:
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An exercise stress test. An electrocardiogram (EKG) is performed while the patient exercises in a controlled manner on a treadmill or stationary bicycle at varied speeds and elevations. The reaction of the heart under exertion can be measured and evaluated. However, the EKG reading may be normal, even for a patient with extensive damage to the heart.
- Nuclear imaging. A nuclear imaging test is a test in which the patient is injected with a radionuclide substance, such as thallium, to produce contrasts (pictures) of the heart. Nuclear tests allow physicians to measure the uptake of blood or nutrients into the heart muscle, which provides a good picture of healthy versus unhealthy heart tissue. Nuclear imagng can be performed in conjunction with exercise as a nuclear stress test.
- Stress echocardiogram. A common type of stress test that combines EKG and echocardiogram to evaluate cardiac ischemia. While the patient is either exercising or has been given a medication that causes the heart to react as if the person were exercising the reaction of the heart under stress can be measured.
- Catheter-based techniques, including a coronary angiogram. During this test, a special dye is delivered through a thin tube to the coronary arteries. This dye appears on an x-ray (radiopaque) and helps physicians pinpoint the location and severity of blockages in the coronary arteries.
- Computed tomography (CT scan or CAT scan). This uses multiple x-ray sensors, or an electron beam, to provide very detailed, three-dimensional images of the heart. This technique allows physicians to obtain very detailed images of the heart while it works. Both multi-sensor computed tomography, which can yield up to 64 angles during a single scan, and rapid electron beam computed tomography, which takes a scan during a single heartbeat, are also used to measure the degree of calcification in the coronary arteries. These tests are useful for people with established heart disease because the degree of calcification is related to heart-attack risk. However, people who have a very low risk of heart attack are not advised to undergo calcium scoring using computed tomography, and people who are at high risk should already be under intensive treatment and therefore are not advised to undergo calcium scoring.
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