How Is Heart Disease Diagnosed?

Heart disease is a broad term for several conditions that affect the heart and its vessels, arteries, or valves. Coronary artery disease (blocked arteries) is the most common type of heart disease, but other types include congestive heart failure, and arrhythmias (abnormal heart rhythm), among others.

If you have symptoms of heart disease or may be at risk for developing a type of heart disease, it’s good practice to make an appointment with your healthcare provider or cardiologist (a doctor who specializes in the heart) for regular screenings.

The testing measures that your healthcare provider will use depend on the specific type of heart disease. But, most healthcare providers can use a general outline for diagnosis. In most cases, a medical history questionnaire, physical exam, and a combination of specialty testing measures can help your provider reach a diagnosis.

Medical History

Your healthcare provider will begin your diagnostic process with an oral medical history questionnaire or an interview about your health and family medical history.

When your provider takes your medical history, they may ask you several questions, including:

• Do you have chest pain, difficulty breathing, or a heart rate that is higher than normal?
• What other symptoms do you have?
• How long have you had symptoms of heart issues?
• How severe are your symptoms?
• Have you ever had heart concerns or a heart attack before?
• Do you have a family history of heart disease?
• Have you had any recent infections, illnesses, or injuries?
• What does your daily lifestyle look like?
• Are you taking any medications right now?

Each healthcare provider is different—some may ask you to elaborate on your symptoms in detail, while others want to get a summary of your symptoms and begin a physical exam.

Physical Exam

A physical exam is a standard part of the diagnostic process. During your appointment, your healthcare provider will perform a routine physical exam, which will likely include:

• Measuring your vital signs (including heart rate, blood pressure, temperature)
• Listen to your heartbeat and breathing via a stethoscope 
• Check your body for physical symptoms, such as swelling, weakness, or pain 

A physical exam alone cannot point to a heart disease diagnosis, but it may help your provider learn about your symptoms and how to move forward with testing, if necessary. Additional testing measures for heart disease can be expensive—it’s important to give your provider all the information you have about your symptoms so they can calculate the exact tests you may need for a diagnosis. 

Blood Tests

Your healthcare provider may consider several different blood tests when evaluating your heart health. Blood tests can detect any current heart problems and evaluate your risk for heart disease.

Common blood tests for heart disease may include:

• Basic metabolic panel (BMP): Measures eight substances in your blood, such as glucose, calcium, sodium, potassium, and more
• Comprehensive metabolic panel (CMP): Measures 14 substances in your blood, such as different liver proteins like albumin
• Troponin test: Detects levels of a type of protein in your blood that's involved in muscle contraction
• Lipid panel: Checks cholesterol and triglycerides (a type of fat in your blood)
  
• Brain natriuretic peptide (BNP) test: Measures a hormone that your heart makes
• Complete blood count: Measures count of blood cells, plasma, and other components, along with concentrations of hemoglobin (protein that delivers oxygen to your tissues) and red blood cells (hematocrit)

Other less common blood tests may check for:

• Fibrinogen: Protein that your liver produces
• Homocysteine: Amino acid in your blood 
• Prothrombin: Protein that helps your blood clot
• C-reactive protein (CRP): Inflammation in your body
  

Chest X-Ray

A chest X-ray takes a photo of the organs in your chest, such as the heart and lungs. This is a noninvasive test that checks the size, shape, and location of the heart—and can also show if you have any fluid buildup. 

A radiologist (or, a healthcare provider who specializes in medical imaging) will perform the chest X-ray and work with your primary care provider to understand your test results.

Electrocardiogram 

An electrocardiogram—also known as an EKG or ECG—is a standard medical procedure for heart disease screenings. This is a noninvasive test that can be done in your provider’s office, an ambulance, or a hospital. 

The EKG looks at the electrical activity of your heart and shows your heart rate and rhythm on a special kind of graph paper. The results of an EKG can give your provider clues about structural damage to your heart or the possibility of a previous heart attack.

Based on the results of your EKG, your healthcare provider may want to monitor your heart rhythm more closely to ensure that your heart is functioning as it should. If your provider thinks you might benefit from ongoing heart rhythm evaluation, they may recommend using a Holter monitor—a small recording device that measures your heart activity for several days.

Echocardiogram

An echocardiogram, or “echo,” is a type of ultrasound for your heart that uses sound waves to make a detailed image of your heart. This noninvasive test can check: 

• The structure and motion of your heart
• The size, shape, and strength of your heart muscle 
• How well your heart valves and vessels are working
• How much blood is being pumped from the heart with each heartbeat
• If your heart valves are too wide or narrow
• If you have a tumor or blood clot in your heart chambers 

The echo exam can take up to one hour to conduct. If you are at risk for heart disease, your healthcare provider may use an echo regularly for routine appointments and screenings.

Computed Tomography Scan

A computed tomography scan (CT scan) is a noninvasive test that uses multiple computerized X-rays to create a detailed image of the heart and blood vessels. If your provider orders a CT scan to learn more about your heart condition, the test can show:

• Scarring of the heart muscle
• Fluid buildup around the heart 
• Plaque buildup in your arteries (vessels that carry blood from your heart to your body’s cells)
• Injury to the pericardium (the tissue and membrane sac that surrounds the heart)

A CT scan is a relatively short test and takes up to 10 minutes to complete. 

Magnetic Resonance Imaging 

Magnetic resonance imaging (MRI or cardiac MRI) creates a detailed 2-dimensional or 3-dimensional image of your heart by using magnets and radio waves. An MRI can detect any damage to the heart—including problems with the structure, valves, and chambers.

Because heart disease encompasses many heart conditions, different types of MRIs can check other organs for damage or concerns. The most common MRIs for heart disease take picture of the:

• Heart: Checks for changes in blood flow, blocked arteries, heart muscle tissues, and the pericardium, as well as the possibility of a heart attack
• Brain: Can help diagnose cerebrovascular disease (stroke caused by a blockage in the blood vessels between the heart and brain)
• Legs: Helps check for signs of peripheral artery disease (blockage in the blood vessels between the heart and legs)

MRIs are generally safe for most people. However, you should let your provider know if you wear a metal device before going in for an MRI. Metal devices may include pacemakers, intrauterine devices (IUDs), and cochlear implants, among others.

Cardiac Catheterization and Angiogram 

A cardiac catheterization—sometimes also referred to as an angiogram—is an invasive test that uses a special dye to show the shape and flow of blood in the heart's blood vessels. The test uses small catheters (thin tubes) that your provider will insert into a peripheral artery—most commonly in the wrist or groin (hip area)—that leads to the arteries in your heart. Once the catheters are put in, your provider will inject the special dye to help make a moving X-ray of the blood flow.

This test can help your provider identify if your arteries are narrow or if there are any blockages in your blood flow.

Stress Test 

You can complete most heart disease diagnostic measures while sitting or lying down. The stress test is different.

In most cases, you will do the stress test while exercising—such as walking on a treadmill or using a stationary bike. However, if exercise can strain your condition and overall health, your provider can give you a medication that increases your heart rate and mimics the effect of exercising.

You can stop exercising at any point in the test if you need to. After the test is over, your provider may ask you to sit or lie down so they can check your heart rate, blood pressure, and overall fatigue.

Genetic Testing

Heart disease can be common in families, so it is possible for you to inherit a heart condition from your parents or grandparents. If you have lost a parent or close relative to heart disease, especially at an early age, speak with your healthcare provider about early screening.

Your healthcare provider can conduct genetic tests that take a closer look at your DNA for any genes, biomarkers, or signs of inheriting a heart condition. They may also help you understand lifestyle changes you can make to decrease your personal risk of developing a heart condition.

Screening for Related Conditions

Some symptoms of heart disease can overlap with other health conditions. It is also possible to have more than one kind of heart disease at the same time.

Chest pain—a classic sign of a heart condition—can also appear because of stomach, muscle, or breathing problems. While shortness of breath is common in heart conditions, problems with the lungs, liver, and kidneys can also cause the symptom.

For that reason, your provider may recommend additional testing to rule out other conditions and confirm a diagnosis.

A Quick Review

Heart disease is the leading cause of death worldwide. Unfortunately, symptoms of heart disease can sometimes go unnoticed. That’s why annual visits to your healthcare provider for physical screening are so important.

If you think you may be at risk for heart disease or are displaying symptoms of a heart condition, it is good practice to get tested. Several heart conditions fall under the heart disease umbrella. Your healthcare provider will first take your medical history and perform a physical exam before deciding which testing measures are appropriate for your symptoms.

Your provider may order one or more tests to check your heart health. Some tests are simple and noninvasive, while others use more advanced technology and invasive procedures. The important thing is that the tests will give you and your provider a better understanding of your health. Getting tested for heart disease can be scary, but keep in mind that an early diagnosis gets you started on treatments sooner, which can lead to a healthier and longer life.