Coronary artery disease can be diagnosed in numerous ways. A doctor will decide on which tests to administer depending on the patient's symptoms, medical history, and risk factors. Usually, simple tests are given first and more complicated tests are given later, if necessary.

Diagnostic tests may be invasive or noninvasive. Noninvasive don't involve putting anything (such as instruments or fluids) into the body; invasive tests do.

Noninvasive tests include:

• Electrocardiograms (EKGs or ECGs), the most commonly given tests. They record the electrical activity of the heart and can show evidence of angina or heart attack.
• Holter monitors, ambulatory EKGs that record heart rate and rhythm over 24-48 hours.
• Exercise treadmill (stress) tests, which can detect heart problems that appear only when the heart has to work harder. The patient's heart rhythm and blood pressure are recorded. Patients who can't endure treadmill tests may be given drugs that simulate exercise.
• Ultrasound (echocardiogram) exams, which show moving images of the heart and its internal structure on a computer monitor. They can be combined with stress tests for very accurate results.
• Magnetic resonance imaging (MRI), in which images of the heart are created using a magnetic field and pulses of radio wave energy. MRIs can give different information about the heart than can be seen with CT scan, ultrasound, or other exams.

Invasive tests include:

• Blood tests to determine the presence of inflammation, risk of stroke and clotting, the blood's lipid profile, and many other factors important in diagnosis and treatment of heart disease.
• Computerized tomography (CT or CAT), a technique that uses X-ray methods to visualize the heart's arteries. A contrast dye is injected into the patient's bloodstream to make the arteries visible to X-ray.
• Angiograms, in which a guide wire is threaded into an artery and guided up into the heart. Then a tiny, flexible hose called a catheter is threaded over the wire and an X-ray contrast dye is injected into the coronary arteries. Fast-moving X-ray images are monitored on a screen while the dye flows through the arteries.
• Transesophageal echocardiograms, taken by inserting an ultrasound probe into the patient's esophagus. The pictures of the heart obtained in this way are clearer, because the esophagus lies close to the heart and there is no interference from the chest wall.

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