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The diagnosis of ischaemic heart disease underlying particular symptoms depends largely on the nature of the symptoms. The first investigation is an electrocardiogram (ECG/EKG), both for “stable” angina and acute coronary syndrome. An X-ray of the chest and blood tests may be performed.

Electrocardiography:Electrocardiography (ECG) may be normal in several patients at rest between attacks of Angina. However, during the episodes of pain there may be depression of the ST segment and a T wave inversion in several leads, indicating Ischaemia. In cases of Infarction (heart attack), there will be ST segment elevation in the ECG, which may gradually evolve. An Echocardiogram may help in showing any functional abnormalities in the various cardiac chambers and in assessing the pumping efficiency of the heart.

An exercise testing (Treadmill Test-TMT) is often indicated in patients who have symptoms but have normal ECG patterns. Nowadays, TMT is being indicated in all high-risk categories beyond the age of 35 irrespective of symptoms. Myocardial perfusion scanning with radioactive thallium may also be helpful in the diagnosis. Coronary Angiogram provides accurate information about the actual site and extent of the stenosis (narrowing) and helps in deciding the method of therapy required.

Acute Chest Pain:Diagnosis of acute coronary syndrome generally takes places in the emergency department, where ECGs may be performed sequentially to identify “evolving changes” (indicating ongoing damage to the heart muscle). Diagnosis is clear-cut if ECGs show elevation of the “ST segment”, which in the context of severe typical chest pain is strongly indicative of an acute myocardial infarction (MI); this is termed a STEMI (ST-elevation MI), and is treated as an emergency with either urgent coronary angiography and percutaneous coronary intervention (angioplasty with or without stent insertion) or with thrombolysis (“clot buster” medication), whichever is available.

In the absence of ST-segment elevation, heart damage is detected by cardiac markers (blood tests that identify heart muscle damage). If there is evidence of damage (infarction), the chest pain is attributed to a “non-ST elevation MI” (NSTEMI). If there is no evidence of damage, the term “unstable angina” is used. This process usually necessitates admission to hospital, and close observation on a coronary care unit for possible complications (such as cardiac arrhythmias – irregularities in the heart rate).

Stable Angina: In “stable” angina, chest pain with typical features occurring at predictable levels of exertion, various forms of cardiac stress tests may be used to induce both symptoms and detect changes by way of electrocardiography (using an ECG), echocardiography (using ultrasound of the heart) or scintigraphy (using uptake of radionuclide by the heart muscle). If part of the heart seems to receive an insufficient blood supply, coronary angiography may be used to identify stenosis of the coronary arteries and suitability for angioplasty or bypass surgery.

Depending on the risk assessment, stress testing or angiography may be used to identify and treat coronary artery disease in patients who have had an NSTEMI or unstable angina.

The physical examination may be normal, or it may reveal signs of fluid buildup (leg swelling, enlarged liver, “crackles” in the lungs, extra heart sounds, or an elevated pressure in the neck vein). There may be other signs of heart failure.

The diagnosis of this condition is usually made only if a test shows that the pumping function of the heart is too low. This is called a decreased ejection fraction. A normal ejection fraction is around 55 – 65%. Most patients with this disorder have ejection fractions much less than this. Tests used to measure ejection fraction include:

1.Biopsy of the heart is needed in rare cases to rule out other disorders.
2.ECG
3.MRI of chest
4.Gated SPECT
5.Ventriculogram performed during a cardiac catheterization
6.Echocardiogram

Lab tests that may be used to rule out other disorders and to assess the condition of the heart include:

1.Cardiac biochemical markers (CK-MB, troponin)
2.Blood chemistries
3.Coronary risk profile
4.CBC

If you are experiencing the symptoms of either angina or CHF, you should see your doctor immediately. You also should check with your doctor if you have a family history of heart disease or suspect you may be developing heart problems. Your doctor can assess the situation, starting with a physical exam, and then order the diagnostic tests that he deems appropriate.

CHF, one of the two main conditions likely to result from ischemic heart disease, is characterized by a compromised ejection fraction, a measurement of the heart’s efficiency. MedicineNet.com defines ejection fraction as “the portion of blood that is pumped out of a filled ventricle as a result of a heartbeat.” The normal ejection fraction is between 55 and 65 percent. Your doctor may order a series of tests to pinpoint your ejection fraction. Such tests may include an electrocardiogram, echocardiogram, MRI scan of your chest, or a ventriculogram (performed during a cardiac catheterization).

As a follow-up to a reading on your ejection fraction, your doctor may order a myocardial biopsy, a tissue sample of your heart muscle that is obtained most often during a cardiac catheterization. Other tests that are helpful in identifying the nature and extent of cardiac damage are blood tests that measure the levels of various substances in the blood, including blood enzymes, such as troponin and creatine kinease; lipids, including cholesterol and triglycerides; C-reactive protein; and homocysteine.