Tests to Diagnose Heart Problems

New tests are always being developed to help understand problems affecting the heart. These include disease, injury, and problems present from birth (congenital). These are just a few of the tests that have been used to diagnose heart and blood vessel disease (cardiovascular). For more information, talk to your cardiologist or other healthcare provider:

• Electrocardiogram (ECG). This test records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can sometimes detect heart muscle damage.

• Stress test. This is also called a treadmill or exercise ECG. This test is done to monitor the heart while you walk on a treadmill or pedal a stationary bike. Your healthcare provider also monitors your breathing and blood pressure. A stress test may be used to detect coronary artery disease, or to determine safe levels of exercise after a heart attack or heart surgery. This test can also be done using special medicines that stress the heart in a similar manner as exercise does. Sometimes a stress test will collect ECG information along with heart ultrasound pictures. This is called an exercise or stress echocardiogram. It's more sensitive and specific than ECG stress testing alone.

• Transthoracic echocardiogram (echo or TTE). An echo is a noninvasive test that uses sound waves to evaluate your heart's chambers and valves, and how well it pumps. The echo sound waves create a real time image on the monitor as an ultrasound probe is passed across the skin over your heart.

• Transesophageal echocardiogram (TEE). This test is similar to a transthoracic echocardiogram. But it's done with medicine to help you relax (sedation). It's considered invasive because a probe is put into your body. In this test, you will swallow a small probe about the size of your thumb. The probe passes down the esophagus, which lies directly behind the heart. It allows a much closer look at the heart's structure and function than a standard echocardiogram done on the skin of the chest. It can better look at heart valve structure and function. Your healthcare provider can better see any blood clots that may be in the heart.

• Positron emission tomography (PET) scan. This is a nuclear scan that gives information about the flow of blood through the coronary arteries to the heart muscle:

  • PET F-18 FDG (fluorodeoxyglucose) scan. This specialized PET scan uses a form of radioactive glucose to help determine if any specific areas of heart tissue have permanent damage. Your provider may use it after a heart attack to determine which procedure, such as angioplasty, stenting, or bypass surgery, may be beneficial. The test technician will inject a glucose solution through an IV into your blood. Then a special camera takes pictures of where the solution collects in your heart. 

• Thallium scans or myocardial perfusion scans. Similar to the PET scan, these tests involve an IV injection of radioactive tracer and a special camera.

  • Resting SPECT thallium scan or myocardial perfusion scan. A nuclear scan done while you rest. It's done to view areas of the heart muscle that are not getting blood flow at rest. This might be an area of scar tissue.

  • Exercise thallium scan or myocardial perfusion scan. A nuclear scan is done while you are exercising. It's done to view areas of the heart muscle that are not getting enough blood during activity.

  • Adenosine or persantine thallium scan or myocardial perfusion scan. A nuclear scan that's done if you are unable to exercise. It's done to view areas of the heart muscle that are not getting enough blood. It uses special medicines that stress the heart in the same way exercise does.

  • MUGA scans/radionuclide angiography (RNA) scans. Similar to the PET scan, these tests involve an IV injection of a radioactive tracer and a special camera:

    • Resting gated blood pool scan (RGBPS), resting MUGA, or resting radionuclide angiography. A nuclear scan to evaluate how well the heart wall moves and how much blood is pumped with each heartbeat, while you rest.

    • Exercise gated blood pool scan, exercise MUGA, or exercise radionuclide angiography. A nuclear scan to evaluate how well the heart wall moves and how much blood is pumped with each heartbeat, just after you walk on a treadmill or rode on a stationary bike.

• Holter monitor. For this test, you wear a small, portable, battery-powered ECG machine. Small patches (wired electrodes) are attached to the skin over your heart. The monitor records heartbeats over a period of 24 to 48 hours during normal activities. At the end of the time period, you will return the monitor to the provider's office so it can be read and evaluated. Some Holter monitors can be worn for up to 2 weeks. These monitors are patches and don't require wires.

• Event recorder. For this test, you wear a small, portable, battery-powered machine used to record ECG over several weeks. Each time you have symptoms, you press a button on the recorder to record the ECG sample. As soon as possible, you will transmit this sample to the provider's office for evaluation. Other types of event recorders don't use wires. Instead small cards with electrodes on them are placed on the skin over the heart.

• Implantable loop recorder. This device is about the size of a AAA battery. Your provider puts the device under the skin over the heart. The device monitors and records heartbeats for up to 3 years. 

• Tilt table test. Your provider will connect you to an ECG and blood pressure monitor. You will be strapped to a table that tilts you from a lying to standing position. This test is used to determine if you are likely to have sudden drops in blood pressure (orthostatic hypotension) while standing, or slow pulse rates with position changes. You might need this test if you often have fainting spells.

• Electrophysiology study. For this test, insulated electric catheters are placed through the large vein in the upper leg and threaded into the heart. It's used to test the heart's electrical system. It helps your healthcare provider look at what might be causing abnormal heart rhythms.

• Cardiac catheterization (coronary angiogram). For this test, your provider guides a small catheter (hollow tube) through the large artery in your upper leg, or sometimes your wrist or arm, into your heart. Dye is given through the catheter, and moving X-ray pictures are taken as the dye travels through your heart arteries and heart chambers. This comprehensive test shows narrowing in the arteries, heart chamber size, how well your heart pumps, and how well the valves open and close. It also measures the pressures within the heart chambers, arteries, and veins.

• MRI of the heart. This procedure uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in your body. Your provider may order an MRI of the heart to look at the heart valves and major vessels. It can also detect coronary artery disease and how much damage it has caused. It can also assess heart problems that have been present since birth. It can find tumors and other problems. Your provider may order this test before other procedures such as angioplasty or stenting of the coronary arteries and heart or vascular surgery:

  • Magnetic resonance angiography (MRA) of the heart. This is a special type of MRI procedure used to evaluate blood vessels in your heart. You are given contrast dye. This helps highlight blood flow.

• Cardiac CT scan. This imaging procedure uses an X-ray machine and a computer to create a 3-D pictures of the heart. Sometimes a dye is injected into a vein so that your heart arteries can be seen as well. Sometimes medicine is given to lower your heart rate so it captures a better image. It can also be used to find out how much calcium is in your heart arteries. Calcium is a marker for coronary artery disease.