The diagnosis of CAD is usually never seen until a MI or angina occurs. This preventive therapy is so important for individuals in the risk groups and it is usually determined by exercise stress testing, cardiac catherization, and sometimes radionuclide imaging techniques. A stress test is a noninvasive screening method. The procedure exercises the patient in a controlled setting while monitoring EKG, blood pressure, and heart rate. Cardiac catherization is the definitive diagnostic study for CAD. They use angiography, which a dye is injected into the right and left coronary arteries. The coronary anatomy is outlined and areas of narrowing are identified. A contrast injection of the left ventricle is performed to demonstrate the contractile status of the left ventricle and to obtain an estimation of the left ventricular ejection fraction. These are useful in diagnostic evaluation of selected patients with CAD. .
Angina.
The recurring symptom of CAD is angina and is typically precipitated by exercise. Most angina is caused by exercise, stressful situations, overeating, or exposure to cold. The easiest way to remember these factors are the 4 E's: exercise, emotion, eating, and exposure. Angina usually lasts several minutes and is relieved by rest or nitroglycerin. The terms angina and chest pain are used interchangeably. Although angina, or myocardial ischemia is usually manifested as chest pain, it can alternatively cause a variety of other sensations. It's very important to diagnose angina effectively. Chest pain can occur with conditions other than myocardial ischemia, such as gastroesophageal reflux or pleuritis. Anginal chest pain is usually described as substernal, squeezing chest discomfort or pressure. It is frequently mistaken for heartburn because of its substernal location. Angina also occurs as an abnormal sensation in the chest, epigastric region, neck, back, or arms. Some patients will deny chest pain, but describe a long history of tightness, fullness, numbness, or heaviness.