Suspected coronary heart disease, what tests should be done to confirm diagnosis

Suspected of coronary heart disease, it is recommended to first undergo electrocardiogram, cardiac ultrasound, and blood tests (such as myocardial enzymes, blood lipids, blood glucose), and if necessary, further coronary CT angiography or coronary angiography to confirm the diagnosis. These examinations can help doctors evaluate the structure, function, and vascular blockage of the heart.

1. Electrocardiogram:

Electrocardiogram is the most basic examination for diagnosing coronary heart disease, which can record the electrical activity of the heart. During myocardial ischemia or infarction, characteristic changes such as ST segment depression or elevation, T wave inversion, etc. may appear on the electrocardiogram. But a regular electrocardiogram only has a high detection rate during symptom onset, and may be normal when symptoms are relieved. Therefore, doctors often recommend dynamic electrocardiogram monitoring to continuously record 24-hour or longer cardiac activity to capture transient myocardial ischemia events.

2. Cardiac ultrasound:

Cardiac ultrasound can visually observe the structure, size, wall thickness, and systolic and diastolic functions of the heart. Patients with coronary heart disease may experience local wall motion abnormalities, such as weakened or inactive myocardial contractions in a certain area, indicating insufficient blood supply to that area. Cardiac ultrasound can also evaluate the function of heart valves, the presence of pericardial effusion, and help rule out other heart diseases, making it an indispensable imaging tool in the diagnosis of coronary heart disease.

3. Blood examination:

Blood examination mainly includes myocardial enzyme spectrum (such as troponin, creatine kinase isoenzyme), blood lipids, blood glucose, C-reactive protein, etc. Troponin is a specific marker of myocardial cell injury, and its level significantly increases when the heart muscle is ischemic and necrotic, making it an important basis for diagnosing acute myocardial infarction. Abnormal blood lipids (such as elevated low-density lipoprotein cholesterol) and elevated blood sugar are the main risk factors for coronary heart disease, and these indicators help evaluate the condition and develop follow-up treatment plans.

4. Coronary CT angiography:

Coronary CT angiography is a non-invasive imaging examination that can clearly display the course of the coronary artery, whether there is calcification in the wall, whether there is stenosis in the lumen, and the degree of stenosis by scanning after intravenous injection of contrast agent. It has a high negative predictive value for excluding coronary heart disease, that is, if CT shows no obvious stenosis of coronary arteries, coronary heart disease can be basically ruled out. However, for patients with severe calcification or arrhythmia, the image quality may be affected, and the results need to be combined with clinical comprehensive judgment.

5. Coronary angiography:

Coronary angiography is the gold standard for diagnosing coronary heart disease and is an invasive examination. Doctors puncture the arteries of the wrist or thigh, deliver a slender catheter to the opening of the coronary artery, inject contrast agent, and take X-rays, which can intuitively and accurately display the anatomical shape, stenosis location, degree, and blood flow of the coronary artery. If severe stenosis is found, interventional treatment such as balloon dilation or stent implantation can be performed simultaneously with imaging. This examination is suitable for patients with non-invasive examination indicating high-risk or typical symptoms but unclear non-invasive examination results. After being diagnosed with coronary heart disease, patients should actively cooperate with their doctors for lifestyle interventions, including low salt and low-fat diet, smoking cessation and alcohol restriction, weight control, and regular exercise (such as walking, jogging, and avoiding vigorous exercise). At the same time, it is necessary to strictly follow the doctor's advice to take antiplatelet drugs (such as aspirin enteric coated tablets), lipid-lowering drugs (such as atorvastatin calcium tablets), etc., and regularly check electrocardiogram, blood lipids, blood glucose and other indicators. If symptoms such as chest pain, tightness, shortness of breath worsen or persist, seek medical attention immediately.