print   Print full article


When testing for heart disease, the goal is to distinguish between heart-related symptoms and symptoms that are caused by another condition. Testing is ordered to help determine which heart disease is present, whether the disorder is acute or chronic, and the severity and extent of the disease. It is also ordered to monitor a cardiac event that is in progress (such as a heart attack).

When a patient presents to the emergency room with acute coronary syndrome – a group of symptoms that suggest heart injury due to a lack of blood flow – they are evaluated with a variety of laboratory blood tests and other tests. These are used to determine the cause of the pain and the severity of the condition. Since some treatments for a heart attack must be given within a short period of time to minimise heart damage, an accurate diagnosis must be quickly confirmed.

Heart disease that is causing few symptoms may be detected during a visit to the doctor for nonspecific symptoms such as fatigue. Doctors may order a variety of blood tests and other tests to investigate possible causes for the patient’s symptoms. Diagnosis of heart disease in these people may take time and patience.

Testing patients for existing heart disease is not the same as cardiac risk testing (which gives a measure of the risk of coronary heart disease). Cardiac risk testing is performed to screen asymptomatic people – i.e., to help determine their risk of developing coronary heart disease.

Laboratory blood tests

Cardiac biomarkers - proteins that are released when muscle cells are damaged - are frequently ordered when patients have symptoms of acute coronary syndrome, such as chest pain; pain in the jaw, neck, abdomen, or back, or pain that radiates to the shoulder or arms; nausea; dyspnoea; and lightheadedness.

Doctors will test for:

  • Cardiac troponin I or T  (This is the most commonly ordered and cardiac-specific of the markers. It will be elevated within a few hours of heart damage and will remain elevated for up to two weeks.)
  • CK-MB (This one particular form of the enzyme creatine kinase which is found mostly in heart muscle and rises when there is damage to the heart muscle cells. This test has been replaced by the more specific cardiac troponin test.)
  • Brain natriuretic peptide (This is released by the body as a natural response to heart failure. Increased levels of BNP, while not diagnostic for a heart attack, indicate an increased risk of cardiac problems in persons with acute coronary syndrome.)

The heart also releases BNP when it is stretched, and for this reason BNP is also measured in those who have swelling in the legs or abdomen or shortness of breath to see if heart failure may be present.

More general blood tests that may be ordered:


Other evaluations

A range of other evaluations and tests are used to assess chest pain and other symptoms. These include:

  • A medical history, including an evaluation of risk factors (such as age, CAD, diabetes, and smoking)
  • A physical examination
  • An electrocardiogram or ECG (which looks at the heart’s electrical activity and rhythm)
  • Echocardiography (ultrasound imaging of the heart)

Based on the findings of these tests, other procedures may be necessary, including:

  • Stress testing
  • A chest X-ray
  • CT (Computerised tomography) scan
  • Continuous ECG monitoring (sometimes also called Holter monitoring, where the patient wears a monitor that evaluates heart rhythm over a period of time)
  • MRI (Magnetic resonance imaging)
  • PET (Positron emission tomography)
  • Radionuclide imaging
  • Cardiac catheterisation (a thin flexible tube is inserted into an artery in the leg and threaded up to the coronary arteries to evaluate blood flow and pressure in the heart, as well as the status of the arteries in the heart)
  • Coronary angiography (X-rays are taken of the arteries using a radio-opaque dye to help diagnose CAD; this procedure is performed during coronary catheterisation)
  • Tilt table test (to evaluate syncope)

Last Review Date: September 4, 2017