Tests and investigations

If you have high cholesterol or symptoms of heart disease, your healthcare professional will want to find out more about your overall health and your risk of illness. You might then be offered further tests to make a diagnosis and a treatment plan. 

Finding out about your risk of heart disease

If your healthcare professional thinks you might be at risk of heart disease, they will ask questions and do some simple tests and checks to find out more about what's going on. This will give them an idea of your risk of developing heart disease and related conditions in the next 10 years and over your lifetime, such as having a heart attack or stroke. You might also have these tests and checks as part of an NHS Health Check.

These may include: 

  • a cholesterol test
  • a blood pressure check
  • a check for atrial fibrillation – a type of irregular heart beat 
  • questions about any symptoms you have and your medical history
  • questions about your family history – for example, if other people in your family have had heart disease or a stroke
  • questions about your lifestyle – such as whether you smoke, how much alcohol you drink, and how physically active you are
  • your weight – to find out if you are a healthy weight for your height and have a healthy waist size. 

You may then be referred for further tests and might see other healthcare professionals such as:

  • a cardiologist – a doctor who specialises in diseases of the heart and blood vessels 
  • a lipidologist – who specialises in high cholesterol and high triglyceride problems. 

Further tests and checks 

Your healthcare professional can request further tests and checks if you need them. Which ones you have will depend on your test results so far combined with their expertise and clinical judgement.

These tests can give more detailed information about the health or your heart and blood vessels, helping to make a diagnosis and plan any further tests and treatment.

ECG (electrocardiogram)

A simple test to check your heart’s rhythm and electrical activity. Sensors will be placed on your skin to detect the electrical signals in your heart as it beats. This can help to find out if you have an irregular heart beat, blocked blood vessels to the heart, heart attacks, and cardiomyopathy, where the walls of the heart are enlarged.

Exercise ECG

This is where you have an ECG while exerting yourself, for example on a treadmill or exercise bike.

Echocardiogram

Despite the similar name, this is different to an ECG (electrocardiogram). It’s a type of ultrasound scan that’s used to look at your heart and blood vessels. Your healthcare professional will use a small probe on your skin which sends out sound waves that create echos when they bounce off tissues in the body. You might also hear it called an ‘echo’. It can pick up on different types of heart conditions.

X-ray

A type of scan that uses radiation to give images of the inside of the body. The waves of radiation can’t pass easily through dense parts of the body such as bone, so they show up as lighter areas on the scan, while soft tissues are darker.

X-rays mean you are exposed to a small amount of radiation. Although this carries a small risk of causing cancer many years or decades later, this risk is thought to be very small.

Coronary angiogram (also called cardiac catheterisation) 

An angiogram is a type of X-ray scan where a type of dye is injected into a blood vessel so that the blood vessels show up clearly. If the scan is of the heart and the blood vessels around it, this is called a coronary angiogram.

This is an invasive procedure where you have a catheter (a thin flexible tube) inserted into a blood vessel in your arm or groin. The catheter is passed into your heart, using X-rays as a guide, and the dye is injected into the blood. The dye shows up clearly on the scans and can show any blocked or narrowed areas of the blood vessels. 

It can give information about the structure and function of the heart and can be used to diagnose conditions such as coronary heart disease, where the blood vessels become clogged up, and plan treatment such as coronary angioplasty, where narrowed areas of blood vessels are widened. 

The dye may give you a 'flushing' sensation, and the X-ray scans will mean you are exposed to a small amount of radiation, but the risks linked to this are thought to be small. 

Cardiac CT scan (computerised tomography scan)

This uses X-rays and a computer to create 3D, detailed images of the inside of the body. You might hear them called CAT scans or computed tomography scans. When the CT scan is of the heart and the blood vessels around it, it's called a cardiac CT scan. You will need to lay on a table inside a large circular scanner to have the scan.

As with X-ray scans, you will be exposed to a small amount of radiation. 

CT calcium scoring

This is a form of CT scan which measures calcium. It is used to check for fatty deposits in your arteries known as plaque, as plaque contains calcium. You will be given a calcium score, and if your calcium score is above 0 you will normally go on to have another test such as a CT coronary angiogram.

CT coronary angiogram 

This takes a detailed look at the coronary arteries which supply the heart with blood. It is a type of CT scan of the heart and surrounding blood vessels where a special type of dye is injected into the blood, usually through the skin in your arm, so that the blood vessels show up more clearly on the scans. This means any narrowed areas or blockages can be seen, and can explain symptoms such as angina (chest pain) and can be used to make a diagnosis. 

This is less invasive than a coronary angiogram because you don't need to have a catheter (a flexible tube) inserted into a blood vessel. The dye may give you a 'flushing' sensation. 

The HeartFlow Analysis

This is a new test which uses CT scans and a series of calculations to create a 3D model of the heart and surrounding blood vessels. It shows any blocked or narrowed blood vessels and works out how much these are affecting blood flow. You might be offered this is you have already had CT scans which show blocked or narrowed areas in the blood vessels. 

The HeartFLow Analysis can work out whether enough blood is flowing to all areas of your heart. It can show if you would benefit from invasive treatments such as angioplasty or stents to widen the narrowed areas, and means you can avoid these if you don't need them. 

Learn more about The HeartFlow Analysis from our recent webinar with AHSN Network and NHS England.

 

Myocardial perfusion scan

These scans use a small amount of a radioactive substance injected into your blood to create images the heart and blood vessels. They can show the blood flow to your heart and the pumping action of the heart.

You might hear it called a thallium scan, MIBI scan, technetium scan or nuclear medicine scan.

MRI scans (magnetic resonance imaging  scans)

This type of scan uses magnets and radiowaves to create very detailed images of the inside of the body. 

Blood tests - coming soon 

We will have more information on other blood tests soon, including: 

  • CRP
  • CK
  • LDL particle testing
  • LP-PLA2 tests