Evaluation and Diagnosis of Angina Pectoris
Diagnosis and assessment of angina involve clinical assessment, laboratory tests and specific cardiac investigations.
In the majority of cases, it is possible to make a sure diagnosis based on the history alone, although physical examination and further tests are necessary to confirm the diagnosis and to evaluate the severity of underlying disease.1
The evaluation of patients with chest pain should take into account symptom characteristics and cardiovascular risk factors, as these may indicate the probability of angina and coronary artery disease (CAD).
If the history and physical examination suggest the presence of angina and CAD, patients are further evaluated by noninvasive tests such as exercise treadmill testing or coronary angiography.
Laboratory Tests
- Comprehensive metabolic panel—Includes assessment of the patient’s kidneys, liver, electrolyte, acid/base balance, blood sugar, lipid profile and blood proteins.
- Cardiac biomarkers—These are proteins that are released when myocardium cells are damaged. They help to differentiate angina from a heart attack. If the cardiac biomarkers are normal, then the chest pain is more likely to be due to angina and much less likely due to heart muscle damage.2
The commonly investigated markers include:
- Troponin—A cardiac-specific marker. It will be elevated within a few hours of heart damage and remain elevated for up to 2 weeks.
- CK-MB—A form of the enzyme creatine kinase found mostly in heart muscle and rises, when the heart muscle cells are damaged.
Non-Laboratory Tests
- An electrocardiography (ECG)—Evaluates the heart’s electrical activity and rhythm. During chest pain, depression or elevation of the ST segment may be recorded.
- Echocardiography—Ultrasound imaging of the heart.
- Radionuclide imaging—A radioactive compound injected into the blood to evaluate blood flow. This shows images of narrowed blood vessels around the heart.
- Coronary catheterization—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 and the status of the arteries in the heart.
- Coronary angiography—X-rays of arteries using a radiopaque dye, performed during coronary catheterization.
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Written by: Healthplus24 team
Date last modified : July 03, 2011