Diagnosis

To diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.

There are several tests your doctor may order to help confirm whether you have angina:

• Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. An electrocardiogram records these electrical signals as they travel through your heart. Your doctor can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed or interrupted or if you're having a heart attack.
• Stress test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle. Your blood pressure and ECG readings are monitored as you exercise. Other tests also may be done at the same time as a stress test. If you're unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising followed by an imaging test.
• Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. Your doctor can use these images to identify angina-related problems, including heart muscle damage due to poor blood flow. An echocardiogram can be given during a stress test, and this can show if there are areas of your heart that are not getting enough blood.

• Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream.

  This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — shows how the substance moves with the blood in your heart muscle. Poor blood flow to any part of your heart can be seen on the images because not as much of the radioactive substance is getting there.

• Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
• Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.

• Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization.

  During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.

• Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.
• Cardiac MRI. In a cardiac MRI, you lie on a table inside a long, tubelike machine that produces detailed images of your heart's structure and its blood vessels.