How a doctor decides which tests to order for coronary artery disease

If your doctor suspects that you have coronary artery disease (CAD), you will have an electrocardiogram (EKG or ECG) and possibly a chest X-ray. Based on your symptoms, risk factors, and test results, your doctor will estimate how likely it is that you have CAD.

You may need to undergo a stress test if your doctor is still not certain whether you have CAD. A stress test may also be helpful if your doctor is sure that you have CAD but wants to help estimate its severity.

Cardiac catheterization is also sometimes required to find out whether you have CAD and how severe it is.

How does my risk of CAD affect my doctor's choice of tests?

After reviewing your symptoms and risk factors, as well as the results of your physical exam and EKG (and possibly a chest X-ray), your doctor will come to one of the following conclusions:

• You most likely have CAD. Your doctor will probably start you on medicines to control symptoms. If your symptoms persist despite medicines, your doctor may recommend that you have either a stress test or cardiac catheterization. These tests can confirm that you do have CAD, determine how severe it is, and help identify the best treatment.
• You may have CAD, but there is still some doubt. Your doctor will likely want you to get a stress test. Based on your stress test results, your doctor will decide either that you probably have CAD and start treating you for it or that you probably do not have CAD and treatment is not needed.
• You probably do not have CAD. Your doctor may still want you to get a stress test just to be sure. But, an abnormal stress test does not always mean that you have CAD, especially if you are at low risk for CAD. Your doctor may decide that you do not need a stress test or any other testing or treatment, other than having you come in for regular checkups to make sure that you still don't have any signs or symptoms of CAD.

In every case, both you and your doctor must decide on the best course. There is no absolute right answer.