Tests & Diagnosis of Acute Coronary Syndrome
Acute Coronary Syndrome (ACS) requires urgent assessment and treatment. Tests and treatments will therefore usually be undertaken as an emergency in a hospital.
To make a diagnosis of ACS the doctor starts by carrying out an assessment by:
- Asking questions about what brings on the pain and what relieves it and ruling out other possible causes of pain
- Finding out more about you and your family’s medical history
- Checking for any risk factors that may be contributing to your symptoms such as smoking
- Taking your blood pressure and checking your weight
- Taking blood to check:
- your haemoglobin for anaemia
- your blood glucose for diabetes
- your cholesterol level.
- You should also have a blood sample taken to check Troponin levels. Troponin is a protein found in heart muscle cells. It is raised when the muscle is damaged and should be checked 12 hours after the start of any symptoms
- Taking an ECG (electrocardiogram). This gives a record of the electrical activity of the heart when you are at rest. This is a painless test where small patches called electrodes are attached to your chest, wrist and ankles
A confirmed diagnosis of ACS will be made based on clinical history, ECG and Troponin levels.
Further Tests and Investigations
Not all of these further investigations will be relevant to you – it depends on the type and severity of your ACS.
Exercise ECG or Exercise Treadmill Test (ETT): This is not a way of measuring how fit you are. An ETT records the activity of your heart as you walk on a treadmill. There will be staff to supervise you throughout. It is used to help diagnose coronary artery disease and assess its severity.
Chest x-ray: This is a picture taken using high frequency radiation. The health of your lungs, heart, bones and gullet can be checked using an x-ray.
Echocardiography: Known as an ‘echo’ this is an ultrasound scan of the heart. High frequency pulses are sent via a probe on the chest. Lubricant jelly is rubbed on the chest first to ensure good contact.
An ‘echo’ shows the structure of the heart. The speed and direction of blood flow within the heart can also be looked at. The test is not painful.
Myocardial Perfusion Scan: This is helpful in people who are not suitable for an ETT. A tiny amount of radioactive material is injected into the blood stream. A special camera is able to show the heart muscle working and assess the extent of the problems resulting from narrowed arteries.
Angiography (cardiac catheterization or coronary angiography): This is an x-ray examination of the coronary arteries. Under local anaesthetic a catheter (thin tube) is inserted into a main artery in the wrist, arm or groin and then passed gently through the blood vessels until it reaches the heart. Injecting some dye through the catheter allows the coronary arteries to be seen using a special camera. These show up any narrowing in the arteries.
NHS Tayside have produced further information on Cardiac Catheterisation.
MRI Scan: Magnetic Resonance Imaging allows pictures of your heart to be taken by putting you inside a large magnet. You need to lie very still and take off all jewelry. This test is painless but you may here ‘knocking’ while the scan is being done.
Doppler ultrasound: This is an ultrasound scan which studies the speed and direction of blood flow through the heart.
TOE (transoesophageal echocardiogram): This is an ultrasound which allows the back of the heart to be seen using a special probe that is swallowed. The tube is not large and is usually passed after some light sedation and a local anaesthetic.
PET: Positron Emission Tomography is a very specialized nuclear scan that can show blood flow within the heart.
The information in this page has been adapted from the CHSS leaflet Heart Attack: A Guide to your Recovery.
Last updated: 23/11/2007