Angina, stable

Tests for angina

The most common tests for angina are listed below.

Source:
Gibbons RJ, Abrams J, Chatterjee K, et al.
ACC/AHA 2002 guideline update for the management of patients with chronic stable angina.
November 2002. Available at http://circ.ahajournals.org/cgi/reprint/107/1/149 (accessed on 16 February 2009).

¹ You'll probably be able to have an electrocardiogram (ECG for short) in your doctor's office. Other tests typically are done at a hospital or in a specialist's office.

Electrocardiogram (ECG)

An ECG is one of the most important tests doctors can use to find out if your chest discomfort or pain is coming from a lack of oxygen to your heart.

When you have this test, small sensors (called electrodes) are put on your chest. They pick up the electrical activity in your heart.

Wires from the sensors go to a machine. The machine shows the electrical activity as a line on a graph.

ECGs don't hurt and don't affect your heart.

From this test, your doctor can tell:

If you've had a

heart attack
Doctors call a heart attack an acute myocardial infarction (or acute MI). This is the name for the damage that occurs to the heart muscle if it isn't getting enough blood and oxygen because a branch of the coronoary arteries is blocked. During a heart attack, you may have pain or heaviness over your chest, and pain, numbness or tingling in your jaw and left arm.

heart attack before
How fast your heart is beating
If your heart is beating in a regular pattern
If your heart chambers are a normal size
How thick the walls of your heart are.

The ECG is often normal in people with angina. But it can show changes during or just before you have an attack of angina. This is the idea behind a stress test (see below).

Stress test

Stress tests make your heart work harder. This lets them uncover problems that don't show up while you're resting.

A stress test can help your doctor tell if you have narrowing of the arteries that carry blood to your heart (your

coronary arteries
Coronary arteries are the vessels that supply blood to the heart muscle. If yours are blocked, you may have a pain in your chest (known as angina) or a heart attack because parts of the heart are not getting enough blood and oxygen.

coronary arteries). Doctors call this condition coronary artery disease. And the test might show how bad the narrowing is. This can help your doctor decide if you should be offered more tests and maybe surgery.

There are two kinds of stress tests, described below. Your doctor will tell you which kind is best for you.

Exercise stress

An exercise stress test shows how much exercise you can do before your heart is put under too much strain. For this test, you walk on a treadmill. Your doctor may speed up the treadmill or make it steeper. At the same time, you have an electrocardiogram (see above) and your

blood pressure
Blood pressure is the amount of force exerted by the blood on the walls of the vessels that carry it. You can think of it like the water pressure in your home: the more pressure you have, the faster and more forcefully the water flows out of the shower. Blood pressure is measured in millimeters of mercury (written as mm Hg). When your blood pressure is taken, the measurement is given as two numbers, for example 120/80 mm Hg. The first, higher, number is called the systolic pressure, and the second, lower, number is the diastolic pressure. The systolic number is the highest pressure that occurs while the heart is pushing blood into the arteries. The diastolic number is the lowest pressure that happens when the heart is relaxing and is not pushing the blood.

blood pressure is measured.

Your doctor will look at your ECG for changes that happen when your heart isn't getting enough oxygen. You may have bad coronary artery disease if any of the following things happen during this test:

You get chest pain
You get short of breath
Your ECG is abnormal
Your blood pressure goes down.

In general, the more exercise you can do during the stress test, the more likely your doctor is to say that you have a good outlook.

But the results of your stress test may be normal even if you have coronary artery disease, or they may suggest you have bad disease when you don't.

¹ If your doctor suspects a problem, he or she will probably suggest a test called coronary angiography.

Exercise stress testing is very safe. It is always done by well-trained doctors or other professionals. There's a slight risk that this test could bring on a

heart attack
Doctors call a heart attack an acute myocardial infarction (or acute MI). This is the name for the damage that occurs to the heart muscle if it isn't getting enough blood and oxygen because a branch of the coronoary arteries is blocked. During a heart attack, you may have pain or heaviness over your chest, and pain, numbness or tingling in your jaw and left arm.

heart attack or a dangerous irregular heartbeat. But this is very rare. Because of this risk, there are guidelines for doctors saying who shouldn't have an exercise ECG.

Your doctor might do an echocardiogram (see below) while you have an exercise test.

Non-exercise stress test

If you can't exercise or you have an abnormal ECG while you are resting, your doctor might suggest you have a non-exercise stress test instead. This test doesn't involve any exercise.

For this test, your doctor can give you a drug to make your heart work harder. And he or she might also use a test called echocardiogram (see below) or a special scan, called a nuclear scan, to see how your heart is working. (During a nuclear scan, radioactive chemicals are injected into your blood. The chemicals stick to

red blood cells
Red blood cells are the part of your blood that makes it red. Their main job is to carry oxygen from your heart and lungs out to the tissues of your body. Once these cells unload oxygen, they pick up carbon dioxide. They take carbon dioxide back to your lungs so you can breathe it out of your body.

red blood cells and travel through your bloodstream and heart. Doctors can then use a special scanner see images of your heart and blood vessels.)

Echocardiogram

An echocardiogram uses sound waves to tell doctors how well your heart is working. It's a type of

ultrasound
Ultrasound is a tool doctors use to create images of the inside of your body. The ultrasound machine sends out high-frequency sound waves, which are directed at an area of your body through a device such as a probe. The waves reflect off parts of your body to create a picture. Ultrasound is often used to see a developing baby inside a woman's womb.

ultrasound test.

For this test, an instrument that sends and picks up sound signals is put on your chest. The sounds (echoes) it picks up show up on a screen as a picture.

This test is safe and it doesn't hurt.

From this test, your doctor can tell:

How well your heart chambers fill with blood and pump it to the rest of your body
If your heart muscle has any damage
If your heart is a normal size
If your heart valves are working properly.

Coronary angiography

Coronary angiography is a type of

X-ray
X-rays are pictures taken of the inside of your body. They are done by passing very small amounts of radiation through your body and onto film. X-rays can also be used as a treatment, such as in radiation therapy for cancer.

X-ray that shows your coronary arteries. Your doctor might suggest this test if he or she thinks you have bad coronary artery disease.

A special type of X-ray can show blocked arteries.

This test is done in an X-ray laboratory. You might hear doctors call it the cath lab. Before the test, you may be given medication to make you sleepy.

When you have angiography, doctors put a thin tube (called a catheter) through an artery in your arm or thigh and into your heart. Then they inject dye through the tube into your coronary arteries. When they take the X-ray, the dye shows up.

From this test, your doctor can tell how badly your coronary arteries are narrowed. If it shows that your arteries are very narrow, your doctor may suggest you have a procedure to widen them.

Your doctor might also suggest you have a special type of angiography called CT angiography. This test looks at your coronary arteries using a

CT scan
A CT scan is a type of X-ray. It takes several detailed pictures of the inside of your body from different angles. CT stands for computed tomography. It's also called a CAT scan (computed axial tomography).

CT scan, so you don't need to have the tube put in.

Sources for the information on this page:

Gibbons RJ, Abrams J, Chatterjee K, et al.ACC/AHA 2002 guideline update for the management of patients with chronic stable angina.November 2002. Available at http://circ.ahajournals.org/cgi/reprint/107/1/149 (accessed on 16 February 2009).

This information was last updated on Apr 14, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

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