The first signs of atherosclerosis may be found during a routine physical examination by a physician. Prior to the examination, the physician will obtain a medical history with emphasis on risk factors, such as:

• Family history of cardiovascular problems
• Type and duration of diabetes
• Past levels of glucose and cholesterol

• History of blood pressure problems
• Smoking and use of alcohol
• Diet and exercise habits
• Symptoms of artery damage, such as chest pain, muscle cramping or numbness

In the examination, the physician will look for indications of narrowed or hardened arteries, including:

• Whooshing sounds (bruits) heard by a stethoscope when listening to the arteries
  
  
• Weak or absent pulse below the narrowed part of the artery
  
  
• Evidence of poor healing of a wound or sore in the areas where restricted blood flow is suspected
  
  
• Decreased blood pressure in an affected arm, leg or foot
  
  
• Signs of pulsing bulge (aneurysm) in the abdomen or behind the knee

To help diagnose atherosclerosis, the physician may recommend several tests, including:

• Blood tests. These can be used to check for increased levels of cholesterol, triglycerides, glucose, C-reactive protein (a general indictor of inflammation) or homocysteine.
  
  
• Ankle brachial index (ABI). This test uses a blood pressure cuff and a Doppler ultrasound device to measure blood flow. The physician measures and compares the blood pressure between the arm and ankle. The normal range is 0.95 to 1.2. If the ABI measurement does not fall within that normal range, it indicates peripheral artery disease, which is usually caused by atherosclerosis.
  
  
• Electrocardiogram (EKG). An electrocardiogram measures the electrical impulses from the heart through electrode patches attached to the skin. It can help detect heart problems. An exercise stress test, in which an EKG is performed while the patient uses a treadmill or stationary bicycle, may also be recommended, with or without a harmless nuclear contrast medium.
  
  
• Doppler ultrasound. This test allows a physician to see arteries throughout the body. It also allows blood pressure to be measured at various points along the arm or leg to determine any blockage in the arteries. An ultrasound of the heart is called an echocardiogram.
  
  
• Other imaging tests. Chest x-rays, CAT scan (computed axial tomography) and MRI (magnetic resonance imaging) allow a physician to view the arteries. They can help determine the presence and extent of blockage. These tests often show hardening and narrowing of large arteries, calcium deposits and aneurysms. A newer form of CAT scan, called multi–detector computed tomography (MDCT), has shown advantages over the traditional electron beam computed tomography (EBCT) in detecting atherosclerosis.
  
  
• Angiography. If advanced atherosclerosis is suspected, a physician may perform a coronary or carotid angiogram, a type of arterial x-ray. A thin tube (catheter) is threaded through a blood vessel, usually the femoral artery in the upper thigh, and guided to the coronary arteries of the heart or a carotid artery in the head. The physician then injects a dye (contrast medium) through the catheter to enhance x-rays. In some cases, coronary blockages can be treated immediately through the catheter while it is still in place.