Heart Disease Health Center

Diagnosing Atherosclerosis

Atherosclerosis is sneaky. It's a process that starts early in life, progressing silently. By the time symptoms occur, atherosclerosis is advanced and represents a serious problem.

There are tests for diagnosing atherosclerosis, but none of them are perfect. Some of them even have some risk of harm. So testing isn't as simple as you might think.

If you're concerned about atherosclerosis, what should you do? What can you expect at the doctor's office if you ask about an atherosclerosis diagnosis? We'll answer these and other commonly asked questions about diagnosing atherosclerosis.

Atherosclerosis Warning Signs and Symptoms

What are the symptoms of atherosclerosis? There are three serious diseases caused by atherosclerosis. Each has its own warning signs:

• Coronary artery disease: The warning sign for atherosclerosis in the heart is chest pain on exertion, or angina. It's often described as tightness and goes away with rest. Other symptoms may include shortness of breath or fatigue.
• Cerebrovascular disease: Often, a transient ischemic attack (TIA) may happen before a stroke. Difficulty speaking or weakness on one side are symptoms of both strokes and TIAs. The difference: in a TIA, the symptoms go away, usually within an hour, and do not leave permanent brain injury.
• Peripheral arterial disease: The legs usually show symptoms of poor circulation first. Pain in the calf muscles when walking (claudication) is the most common symptom. Poor wound healing or decreased pulses in the feet are other signs.

You shouldn't rely on these signs of atherosclerosis, though. By the time symptoms like these show themselves, serious blockages may already be present. Also, heart attacks and strokes can occur without any previous warning signs.

What if you have no symptoms but are still concerned about your risk? There are ways to detect atherosclerosis, but the process isn't perfect or straightforward.

Tests to Diagnose Atherosclerosis

Diseases caused by atherosclerosis are the most common cause of death in the U.S. Since atherosclerosis is so widespread and so dangerous, you might ask: Why don't we test everyone with the best tests we have?

The one test that can directly show blocked arteries is called angiography. Angiography is an "invasive" test:

• A thin tube is inserted inside an artery in the leg or arm.
• It is then threaded through the body's maze of branching arteries.
• Injected dye shows arteries -- and any blockages -- on a monitor.

As you might guess, angiography involves some risk. Serious complications occur rarely, but it's too high a risk for people who aren't likely to have blockages.

Instead, expert groups developed a system to separate people into risk groups. People can then be tested appropriately, according to risk level. Low-risk people receive risk-free testing. Angiography is usually reserved for people already at high risk of atherosclerosis.