Diagnosis

To diagnose small vessel disease, your health care provider will usually do a physical exam and ask questions about your medical history and family history of heart disease. He or she will likely listen to your heart with a stethoscope.

The tests used to diagnose small vessel disease are similar to those used to diagnosis other types of heart disease and include:

• Stress test with imaging. A stress test measures how the heart and blood vessels respond to activity. You may be asked to walk on a treadmill or pedal a stationary bike while connected to a heart monitor. Or you may be given an IV drug to stimulate the heart in a way similar to exercise. Blood flow to the heart muscle is measured with ultrasound images (echocardiogram) or with nuclear imaging scans.

• Coronary angiogram. This test helps determine if the main arteries to the heart are blocked. A long, thin flexible tube (catheter) is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye makes the arteries easier to see on X-ray images and video.

  Additional tests may be done during an angiogram to measure blood flow through the heart.

• CT coronary angiogram. This other type of angiogram uses a powerful X-ray machine to produce a series of images of the heart and its blood vessels. You'll lie on a long table that slides through a short, tunnel-like machine (CT scanner). Dye injected through an IV in the arm or hand makes blood vessels easier to see on the CT images.
• Positron emission tomography (PET). This test uses a radioactive dye and medication to determine how blood flows from the heart to other parts of the body. After the dye is injected, you usually lie in a doughnut-shaped machine to have images taken of the heart.