To find out if you have or are at risk for coronary artery disease, your doctor will start by doing a physical exam. He or she will ask questions about your health and your risk factors. Risk factors are the things that increase your risk. You may then have several different kinds of tests to check your risk for getting heart disease. If your doctor thinks you have heart disease, you will need more tests to make sure.

Tests to measure your risk for coronary artery disease

There are several tests your doctor can use to check your risk for getting heart disease. These may include:

• Blood pressure tests. High blood pressure increases your risk for heart disease.
• Cholesterol test (a blood test). High cholesterol increases your risk for heart disease.
• Fasting blood sugar test (a blood test) to check for diabetes. If your blood pressure is higher than 135/80, the U.S. Preventive Services Task Force (USPSTF) recommends that you have a test for diabetes.⁵
• C-reactive protein test (a blood test). High CRP levels can mean swelling (inflammation) in the blood vessels, which increases risk for heart disease and heart attack.⁶
• Homocysteine test (a blood test) to check for elevated homocysteine levels and mutations of a specific gene (MTHFR). But this test is rarely done. Studies show that the link between homocysteine levels and heart disease is weaker than once believed.
• Coronary artery calcium scanning. This test uses a special kind of X-ray to check for buildup of calcium in the heart's arteries. The result is a number, or score. If you have a high score, you may need more tests to check for heart disease or to find out how bad it is. For more information, see:

  Should I have a coronary artery calcium scan to check for heart disease?

Depending on your age, health, and family history, you may have some of these tests every year to check your risk. Screening guidelines from the American Heart Association advise regular testing to check blood pressure, blood sugar, and cholesterol levels starting at age 20.

Most doctors agree that you should be checked for heart disease if you are older than 39, have diabetes or more than one risk factor for heart disease, and want to start a vigorous exercise program or plan to have major surgery.

Tests to diagnose coronary artery disease

If your doctor thinks you may have heart disease, you will need some tests to make sure. Most often, the first tests include:

• An electrocardiogram (EKG or ECG).
• A chest X-ray.
• Blood tests.
• An exercise electrocardiogram. This is also called a "stress test."

Other tests may include:⁷

• Cardiac perfusion scan. This test shows if you have enough blood flow to the heart.
• Echocardiogram and stress echocardiogram. This test uses ultrasound to see areas of poor blood flow in the heart. It can also check how well your heart is working after a heart attack. The test can help your doctor find out how much blood your heart is pumping during each heartbeat (ejection fraction).
• Coronary angiogram. This is an X-ray test that creates pictures of the blood flow through your coronary arteries. It allows your doctor to see any blockage or narrowing of the artery. It's done using a soft, thin tube (catheter) that is put in a blood vessel in the arm or groin and gently moved into the heart. Most often, the test is only done if bypass surgery or angioplasty is an option. For more information, see:

  Should I have an angiogram to test for coronary artery disease?