Heart Disease Diagnosis

Some standard and simple exams can give your doctor the first clues on whether you have heart disease.

During your visit, your doctor will:

  • Listen to your heart
  • Take your heart rate
  • Check your blood pressure


An electrocardiogram (also called EKG or ECG) is a test that records the electrical activity of your heart through small electrode patches attached to the skin of your chest, arms, and legs. An EKG may be part of a routine physical exam or it may be used as a test for heart disease. An EKG can be used to further investigate symptoms related to heart problems.

EKGs are quick, safe, painless, and inexpensive tests that are routinely performed if a heart condition is suspected.

Your doctor uses the EKG to:

  • Assess your heart rhythm
  • Diagnose poor blood flow to the heart muscle (ischemia)
  • Diagnose a heart attack
  • Evaluate certain abnormalities of your heart, such as an enlarged heart

Chest X-Ray

It uses a small amount of radiation to produce an image of your heart, lungs, and blood vessels.

Your doctor uses a chest X-ray to:

  • Look at your chest bones, heart, and lungs
  • See if your pacemaker, defibrillator, or other heart devices are in place
  • To check on any catheters and chest tubes you may have

You don’t need to do anything to get ready for it. But you do need to let the technician know if you could be pregnant.

Your X-ray will take no more than 10 to 15 minutes. You’ll have to remove all of your clothes and jewelry from the waist up, and wear a hospital gown. And you have to stand very still while you hold your breath.

The process is painless and simple. It can show your doctor if you have:

  • Fluid in or around your lungs
  • Enlarged heart
  • Blood vessel problems, such as an aortic aneurysm. This is a bulge in your aorta, the vessel that carries blood from your heart to your chest and beyond.
  • Congenital heart disease (heart problems you’re born with)
  • Calcium build-up in the heart or blood vessels, which could make a heart attack more likely

Stress Test

A stress test can determine your risk of having heart disease. A doctor or trained technician performs the test. They’ll learn how much your heart can manage before an abnormal rhythm starts or blood flow to your heart muscle drops.

There are different types of these. The exercise stress test — also known as an exercise electrocardiogram, treadmill test, graded exercise test, or stress EKG — is used most often. It lets your doctor know how your heart responds to being pushed. You’ll walk on a treadmill or pedal a stationary bike. It’ll get more difficult as you go. Your electrocardiogram, heart rate, and blood pressure will be tracked throughout.

  • Don’t eat or drink anything except water for 4 hours before the test.
  • Don’t drink or eat anything with caffeine for 12 hours before the test.
  • Don’t take the following heart medications on the day of your test, unless your doctor tells you otherwise or the medication is needed to treat chest discomfort the day of the test:
    • Isosorbide dinitrate (for example, Isordil, Dilatrate SR)
    • Isosorbide mononitrate (for example, ISMO, Imdur, Monoket)
    • Nitroglycerin (for example, Deponit, Nitrostat, Nitro-Bid)
  • If you use an inhaler for your breathing, bring it to the test.

You may also be asked to stop taking other heart drugs on the day of your test. If you have questions about your meds, ask your doctor. Don’t discontinue any drug without checking with them first.

Tilt Table Test

It’s done in a special room called the EP (electrophysiology) lab.

The head-up tilt table test is a way to find the cause of fainting spells. You lie on a bed and you’re tilted at different angles (from 30 to 60 degrees) while machines monitor your blood pressure, electrical impulses in your heart, and oxygen level.

  • Take all your medications, as prescribed.
  • Not eat or drink anything after midnight the evening before your test. If you must take medications, drink only small sips of water to help you swallow your pills.
  • Bring a list of all your current medications, including the dose.
  • Wear comfortable clothes to the hospital. It is best not to wear any jewelry or bring valuables.
  • Plan to have someone drive you home after your test.
  • If you have diabetes, ask how to take your medications, eat, and drink before the procedure.

It usually takes an hour or two to complete. That may vary, depending on how your blood pressure and heart rate change and what symptoms you have during it.

Cardiac Catherization

Also called cardiac cath, heart cath, or coronary angiogram, is a procedure that allows your doctor to see how well your blood vessels supply your heart. During the test, they put a long, narrow tube called a catheter into a blood vessel in your arm or leg and guide it to your heart with the aid of a special X-ray machine. Doctors use contrast dye that they inject into your blood vessel through the catheter to create X-ray videos of your valves, coronary arteries, and heart chambers.
Your doctor uses cardiac cath to:

  • Check for heart disease (such as coronary artery disease, heart valve disease, or disease of the aorta)
  • Check how your heart muscle is working
  • Decide whether you need further treatment (such as an interventional procedure or bypass surgery)

Your doctor can use cardiac cath to both find and fix problems. Most of the time, you’ll have a procedure to open blocked arteries after the diagnostic part of the cardiac cath. Procedures that might be done during your cardiac cath include:

  • Angioplasty. Your doctor inserts a catheter with a tiny balloon at the tip. When this balloon is inflated, it pushes plaque out and widens your artery.
  • Biopsy. Your doctor takes a small sample of tissue from your heart.
  • Repair of heart defects. Your doctor closes a hole in your heart or stops a leak in a valve.
  • Stent placement. Your doctor places a tiny mesh tube called a stent into your artery to help keep it open.

A cardiac cath is generally safe. But as with any procedure that involves going into your body, there are risks. Your doctor will discuss the risks with you and be careful to lessen the chances of having them.

Electrophysiology Test

An electrophysiology (EP) study is a test that records the electrical activity and the electrical pathways of your heart.

It can help find what’s causing your irregular heartbeat. It also helps figure out the best treatment for you.

During the EP study, your doctor will safely reproduce your heart rhythm. Then, they may give you different medicines to see which controls it best.

Sometimes, one of these studies is done before you get an implantable cardioverter/defibrillator (ICD). It can help your doctor discover which device is best for you. It can also help them track treatment success.

CT Heart Scan

Computed tomography, commonly known as a CT scan, combines multiple X-ray images with the aid of a computer to produce cross-sectional views of the body. Cardiac CT is a heart-imaging test that uses CT technology with or without intravenous (IV) contrast (dye) to visualize the heart anatomy, coronary circulation, and great vessels (which includes the aorta, pulmonary veins, and arteries).

Myocardial Biopsy

Or cardiac biopsy, is an invasive procedure to detect heart disease. It entails using a bioptome (a small catheter with a grasping device on the end) to obtain a small piece of heart muscle tissue that is sent to a laboratory for analysis.

Cardiac MRI

Magnetic Resonance Imaging uses large magnets and radio waves to make pictures of your body’s internal organs. You’re not exposed to X-rays. This can also make images of your heart’s pumping cycle.


Also called a pericardial tap, is a procedure in which a needle and catheter remove fluid from the pericardium, the sac around your heart. The fluid is tested for signs of infection, inflammation, and the presence of blood and cancer.