Heart Disease – The Path to Diagnosis

Posted on August 16, 2018

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 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.

How is heart disease diagnosed?

Doctors use many tests to diagnose 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 a very 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 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 – called an angiogram – 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. Blood tests for heart disease often include:

  • C-reactive protein (CRP) – Measures 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 – 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.


External resources

MyHeartDiseaseTeam resources


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 the small blood vessels within the heart – as opposed to blockages in the larger coronary arteries typically seen in men. Women’s hearts and blood vessels are also, on average, smaller than men’s. Angiograms are more likely to miss blockages in the smaller arteries. If smaller arterial blockages are not found, a woman will not receive a correct diagnosis or treatment that could reduce her risk for heart attack.

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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