Arteriosclerosis coronary artery – Diagnostics – Overview of Information and Clinical Research

Diagnosing coronary artery atherosclerosis involves a series of tests and examinations that help doctors see how well blood is flowing to your heart and whether plaque has built up in your arteries. Many people do not realize they have this condition until serious symptoms appear, which is why understanding when to seek testing and what diagnostic methods are available is so important for your heart health.

Introduction: Who Should Undergo Diagnostics and When to Seek Them

Deciding when to get tested for coronary artery atherosclerosis can be challenging because this condition often develops silently over many years. Atherosclerosis, which is the buildup of fatty deposits called plaque inside your arteries, usually does not cause any noticeable symptoms in its early stages. In fact, about half of people between ages 45 and 84 have atherosclerosis but are completely unaware of it.^[2]

You should consider seeking diagnostic testing if you experience certain warning signs that suggest your heart is not getting enough blood. Chest pain or discomfort, known as angina, is one of the most common symptoms. This pain might feel like pressure, squeezing, or heaviness in your chest. It can also spread to your shoulders, arms, back, neck, or jaw. Some people describe it as feeling like indigestion.^[2]^[6]

Shortness of breath during light physical activity is another important signal. If you find yourself becoming winded when walking short distances or climbing stairs, when this did not happen before, it could indicate that your heart muscle is not receiving adequate oxygen-rich blood.^[2] Other symptoms that should prompt you to seek medical evaluation include feeling dizzy or lightheaded, unusual fatigue, heart palpitations (feeling like your heart is racing or pounding), or nausea that might feel similar to indigestion.^[2]

⚠️ Important

Many people first discover they have coronary artery disease during a medical emergency like a heart attack. In fact, half of the time, the first symptom a person experiences is actually a heart attack, and half of these heart attacks are fatal.^[12] This is why understanding your risk factors and seeking preventive screening is so important, even if you feel perfectly healthy.

Even if you do not have symptoms, you should discuss diagnostic testing with your doctor if you have certain risk factors. These include smoking, high blood pressure, high cholesterol, diabetes, a family history of heart disease, being overweight or obese, or living an inactive lifestyle.^[2]^[3] Having more than one risk factor significantly increases your chance of developing atherosclerosis. For example, if you have both high blood pressure and diabetes, your risk is much higher than having just one of these conditions.

Age also plays a role in when to seek testing. The risk of atherosclerosis increases after age 45 in men and after age 55 in women.^[2] Women’s symptoms can be quite different from men’s and might include nausea, abdominal pain, and lightheadedness rather than the classic chest pain. Because these symptoms vary from typical presentations, they are sometimes overlooked, making it especially important for women to be insistent about getting carefully checked if they are not feeling well.^[10]

If you notice any new symptoms, especially pain or shortness of breath that awakens you from sleep or occurs while you are at rest, you should seek medical attention promptly. Symptoms that develop gradually can be harder to notice, but any changes resembling chest discomfort, unusual fatigue, or breathing difficulties should be mentioned to your general practitioner or cardiologist.^[10]

Classic Diagnostic Methods Used to Identify the Disease

When you visit a healthcare provider with concerns about coronary artery atherosclerosis, the diagnostic process typically begins with a thorough physical examination and discussion of your medical history. Your provider will listen to your heart with a stethoscope and may hear a whooshing sound called a bruit, which can indicate narrowed arteries.^[7]^[19] They will ask detailed questions about your symptoms, family health history, lifestyle habits, and any risk factors you may have.

Several different tests and imaging techniques are used to diagnose coronary artery atherosclerosis and determine how severely your arteries are affected. These tests help doctors see where blockages are located, how much plaque has accumulated, and whether your heart is receiving enough blood flow.

Blood Tests

Blood tests are often among the first diagnostic tools used. These tests check your blood sugar and cholesterol levels, both of which are important risk factors for atherosclerosis. High levels of blood sugar and cholesterol increase the likelihood of plaque buildup in your arteries.^[19] A lipid profile or lipid panel measures your total cholesterol, LDL cholesterol (often called “bad” cholesterol), HDL cholesterol (often called “good” cholesterol), and triglycerides.^[20]

Your doctor may also order a C-reactive protein (CRP) test, which checks for a protein linked to inflammation of the arteries. Inflammation plays a role in the development and progression of atherosclerosis.^[19]

Electrocardiogram (ECG or EKG)

An electrocardiogram is a quick and painless test that measures the electrical activity of your heart. During an ECG, sticky patches with sensors attach to your chest and sometimes to your arms or legs. Wires connect these sensors to a machine that displays or prints the results. An ECG can show if there is reduced blood flow to your heart muscle.^[19]

Exercise Stress Tests

Stress tests are commonly used to diagnose coronary artery disease. These tests typically involve walking on a treadmill while wearing electrode patches connected to an electrocardiogram machine. If your health prevents you from walking, doctors can use a chemical stress test instead, which relies on medication to increase your heart rate.^[10]^[19]

The goal of a stress test is to get your heart rate to reach about 85 percent of what is normal for your age group. While you exercise, doctors look for changes in the electrocardiogram that might indicate your heart muscle is not getting enough blood. If you walk and are not getting enough blood to the heart muscle, it starts contracting abnormally.^[10]

Imaging Tests

If your stress test suggests a problem, doctors perform follow-up imaging to pinpoint the exact location and severity of blockages. Myocardial perfusion imaging (MPI) allows doctors to watch blood flow in the area near your heart.^[10]

A coronary calcium scan uses computerized tomography (CT) imaging to take pictures of the heart’s arteries. It can detect calcium deposits in the coronary arteries, which can narrow the arteries and increase the risk of heart attack.^[19] A CT scan with dye is another way of revealing spots where blockage exists.^[10]

Echocardiography uses sound waves to create moving pictures of your heart. This test can show how well your heart is pumping and whether there are problems with the heart valves or chambers.^[19]

Nuclear imaging studies involve injecting a small amount of radioactive material into your bloodstream and then using special cameras to see how blood flows through your heart. These studies can identify areas of the heart muscle that are not receiving adequate blood supply.^[19]

Coronary Angiography

If any of the above tests suggest significant coronary atherosclerosis, doctors might recommend an angiography, which is an imaging technique that reveals plaque buildups causing obstruction. This procedure is also known as cardiac catheterization.^[10]^[19] During angiography, a thin tube called a catheter is inserted into a blood vessel, usually in your groin or wrist, and guided to your coronary arteries. A special dye is injected through the catheter, and X-ray images are taken to show where arteries are narrowed or blocked.

Angiography is considered the gold standard for diagnosing coronary artery disease because it provides detailed, precise images of the coronary arteries. It can show exactly where blockages are located and how severe they are. This information is crucial for deciding whether you need procedures like angioplasty or bypass surgery.

Additional Diagnostic Tools

Other specialized tests may be used in certain situations. Doppler velocity probes can measure blood flow speed in your arteries. Fractional flow reserve is a technique used during angiography to measure pressure differences across a narrowed artery segment to determine if the blockage is significantly affecting blood flow.^[13]

Optical coherence tomography is an advanced imaging method that uses light waves to take detailed pictures of the inside of your arteries. It can provide very high-resolution images of plaque buildup.^[13]

Magnetic resonance imaging (MRI) of the heart can provide detailed images of heart structure and function. Positron emission tomography (PET) scans can show how well blood is flowing through the heart muscle and whether certain areas are receiving less blood than they should.^[13]

⚠️ Important

Symptoms of atherosclerosis often do not start until an artery is more than 70 percent blocked.^[2] Many people do not know they have plaque buildup until they have a medical emergency like a heart attack or stroke.^[2] This is why screening and early detection are so important, especially if you have risk factors for heart disease.

Diagnostics for Clinical Trial Qualification

When patients are being considered for participation in clinical trials studying coronary artery atherosclerosis, they typically undergo a comprehensive set of diagnostic tests to determine if they meet the trial’s enrollment criteria. These standard diagnostic procedures help researchers ensure that study participants have the specific characteristics needed for the research.

Clinical trials for coronary atherosclerosis usually require detailed documentation of the extent and severity of arterial disease. This often includes coronary angiography to precisely measure the degree of blockage in the coronary arteries. Researchers need to know exactly which arteries are affected and what percentage of narrowing exists in each blocked area.

Blood tests are standard requirements for clinical trial qualification. Lipid profiles measuring cholesterol levels, blood sugar tests to screen for diabetes, and kidney function tests are commonly required. These tests help researchers understand a patient’s overall cardiovascular risk profile and ensure they do not have other health conditions that would make participation unsafe or confound the study results.^[19]

Electrocardiograms and echocardiograms are frequently required to assess baseline heart function. These tests provide important information about heart rhythm, electrical activity, and how well the heart is pumping blood. Researchers use this baseline data to monitor changes during the trial and to identify any adverse effects.^[19]

Exercise stress tests may be used to objectively measure functional capacity and to document symptoms like angina under controlled conditions. This information helps researchers categorize the severity of a patient’s condition and track improvements or changes during the study.^[19]

Advanced imaging techniques like CT scans, MRI, or nuclear imaging studies might be required depending on the specific focus of the clinical trial. For example, trials testing new medications to reduce plaque buildup might require coronary calcium scans or intravascular ultrasound at the beginning and end of the study to measure changes in plaque volume.^[19]

Blood pressure monitoring is typically required, as high blood pressure is both a risk factor for atherosclerosis and a common condition that needs to be documented and controlled during clinical trials. Some trials might require 24-hour ambulatory blood pressure monitoring to get a complete picture of blood pressure patterns.^[14]

Depending on the trial’s objectives, additional specialized tests might be needed. Trials studying novel diagnostic methods might require emerging technologies like optical coherence tomography or fractional flow reserve measurements. Studies examining the relationship between inflammation and atherosclerosis might require repeated C-reactive protein testing or other markers of inflammation.^[13]^[19]

The specific diagnostic tests required for clinical trial enrollment vary greatly depending on the trial’s design, the intervention being studied, and the research questions being addressed. Potential participants should discuss all testing requirements with the research team to fully understand what will be involved before deciding to participate.

Prognosis and Survival Rate

Prognosis

The outlook for people with coronary artery atherosclerosis varies greatly depending on several factors. How much plaque has built up, where the blockages are located, and how well the condition is managed all affect what happens over time. The good news is that atherosclerosis can be treated, and with proper management, many people live long, active, and fulfilling lives.^[1]

Living with coronary artery disease is possible with heart-healthy lifestyle changes, proper medication, and in some cases, surgical procedures. Research shows that women who maintain a healthy lifestyle could expect to live 14 years longer than those who do not, while men could have 12 more years of life.^[15] This demonstrates that taking positive steps really can make a significant difference in life expectancy and quality of life.

However, untreated or poorly managed atherosclerosis can lead to serious complications. Plaque buildup can take away years of life, especially for people who experience complications. A heart attack takes away more than 16 years of life on average, while people with heart failure lose an average of nearly 10 years.^[15] These statistics underscore the importance of early detection and consistent management.

The risk of life-threatening complications increases as plaque continues to grow in the arteries. Atherosclerosis can cause other health problems including brain conditions like stroke and vascular dementia, heart problems like heart attack and heart failure, and other issues depending on which arteries are affected.^[15] Prevention and treatment of atherosclerosis requires control of known modifiable risk factors through therapeutic lifestyle changes and medical treatment of conditions like high blood pressure, high cholesterol, and diabetes.^[13]

Research shows that atherosclerosis can sometimes be reversed over time by following a heart-healthy lifestyle and taking medicines. All studies that have shown regression of arterial narrowing have done three things: controlled obvious factors like high blood pressure, smoking, and high cholesterol; addressed diet and physical activity; and helped patients manage stress.^[9]^[12] This means that patients who actively participate in their care have a real opportunity to improve their condition.

Survival Rate

Atherosclerosis is very common, and its complications, including heart attacks and strokes, are the leading cause of death worldwide.^[2] Diseases linked to atherosclerosis are the leading cause of death in the United States and around the world.^[3]

Coronary artery disease affects more than 18 million adults over the age of 20 in the United States alone.^[18] In America, about half of people ages 45 to 84 have atherosclerosis but are not aware of it, according to the U.S. National Institutes of Health.^[2] This high prevalence emphasizes the importance of screening and prevention efforts.

While specific long-term survival statistics vary depending on the severity of disease and individual circumstances, findings from the World Health Organization’s Monitor Trends in Cardiovascular Diseases project involving 21 countries showed a 4 percent fall in coronary artery disease death rates. Improvement in the case fatality rate accounted for only one third of the decline; two thirds of the decline resulted from a reduction in the number of events.^[13] This shows that prevention efforts focusing on reducing risk factors can have a major impact on survival at the population level.

The most important message is that having a higher quality of life and a longer life expectancy is achievable with determination and the right attitude.^[18] Early treatment can lower your risk of life-threatening complications.^[2] With the right treatment, symptoms can be reduced and the functioning of the heart can be improved.^[14]

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