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Heart Disease – The Path to Diagnosis

Written by Kelly Crumrin
Updated on May 21, 2021

Heart disease can usually be diagnosed quickly once testing begins. Early on, heart disease symptoms can be mild and may be easily confused with other conditions or signs of aging. Many people do not realize they have heart disease until they have a heart attack.

In the U.S., the average age at first heart attack is about 65 for men and 72 for women. Between 4 percent and 10 percent of heart attacks strike people — mostly men — younger than 45. Read more about risk factors for heart disease.

Many people are diagnosed with hypertension (high blood pressure) by their primary care physician or family doctor. Others may be diagnosed by an emergency department physician after a heart attack, angina (chest pain), or episode of syncope (fainting). Some people are referred to a cardiologist or cardiac surgeon for diagnosis and treatment.

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How Is Heart Disease Diagnosed?

Heart disease is diagnosed on the basis of symptoms you relate to your doctor and signs your doctor finds during an exam. Doctors also use many tests to diagnose or confirm the presence of heart disease. Some tests may be repeated several times to get an accurate idea of how and why the heart is not functioning correctly.

Electrocardiogram (EKG or ECG)

The EKG is an important test for diagnosing heart disease. EKGs are painless, quick, and inexpensive to perform. An EKG monitors the heartbeat using patches that attach to the skin. A standard EKG uses 12 different patches with electrodes attached to leads. The leads go to a machine that senses electrical impulses in the heart and records the pattern of heartbeats. The results of an EKG test can indicate many different types of heart disease, including arrhythmia and whether a person has had a recent heart attack.

An EKG may be performed during a stress test, during which you exercise to raise your heart rate. A Holter monitor is a portable EKG device that is worn for an extended period, usually between 24 and 72 hours. An event monitor uses EKG technology, but records only a few minutes at a time when it is triggered. Event monitors can be worn as long as 30 days.

Imaging Tests

Imaging tests help doctors visualize and diagnose problems with the structure of the heart, such as heart valve disease. Imaging tests are painless and noninvasive. Imaging tests used to diagnose heart disease include computerized tomography (CT), magnetic resonance imaging (MRI), and echocardiogram (or echo), which uses ultrasound.

Cardiac Catheterization

Cardiac catheterization is a more involved procedure. You will be sedated before cardiac catheterization. The doctor will use a needle to make a hole in a blood vessel in your arm, groin, or neck. They will then introduce a thin tube into the blood vessel and guide it into the heart. Once the catheter reaches the heart, the doctor will inject dye (a colorless liquid) that can be seen on X-rays. (This imaging procedure is referred to as coronary angiography.) The doctor may also use ultrasound technology to image the heart from the inside in a procedure known as intracoronary ultrasound. These imaging techniques provide a detailed picture that shows how the heart is functioning and the exact location of any narrowed arteries or blockages.

Cardiac catheterization is also used to perform treatments such as angioplasty and stent placement.

Blood Tests

Blood samples tested in the lab can reveal many important clues about heart disease. These blood tests can help determine your risk of developing heart disease or the impact of any current heart disease. Blood tests for heart disease often include:

  • C-reactive protein (CRP) — This test measures the level of inflammation in the body. High levels indicate raised risk for heart disease.
  • Troponin — High levels indicate recent heart damage.
  • Lipid panel or lipid profile — This test measures levels of cholesterol and other lipids to gauge risk for heart disease.
  • Brain natriuretic peptide (BNP) — Blood levels rise when the heart is damaged.
  • Plasma ceramides — High levels indicate raised risk for heart disease.

Why Is Heart Disease More Difficult to Diagnose in Women?

Heart disease may take longer to diagnose or be misdiagnosed more often in women. Most research on heart disease comes from subjects who are middle-aged men, so doctors are more familiar with the signs and symptoms of heart disease common in men. Women are more likely to develop small vessel disease — blockages in small blood vessels — as opposed to blockages in the larger coronary arteries typically seen in men (which can be easily viewed on aniograms). The reason some women may have a higher likelihood of heart attacks without typical pain or findings on aniograms is unclear.

Heart attacks may also be harder to diagnose in women. Women, especially those with type 2 diabetes, are more likely than men to experience a “silent” heart attack with no obvious symptoms. Some women experience the same crushing chest pain and tightness that men tend to have during heart attacks, but other women have variant heart attack symptoms such as intense fatigue, upset stomach, nausea, and back pain.

Cardiologists experienced in treating women are more likely to recognize the different patterns of signs and symptoms that heart disease can present in women.

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Updated on May 21, 2021
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Larry A. Weinrauch, MD, FACC, FACP, FAHA is an assistant professor of medicine at Harvard Medical School with a focus on cardiovascular disease and clinical outcomes research. Review provided by VeriMed Healthcare Network. Learn more about him here
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here

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