Coronary Artery Disease
Screening Tests

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• What is coronary artery disease?
• What is the purpose of screening tests for CAD?
• What are common initial screening tests for CAD?
  • Exercise Cardiac Stress Test (Treadmill Stress Test)
  • What if the initial ECST does not clarify the diagnosis?
  • Radionucleide Stress Test
  • Stress Echocardiography
  • What if patients are unable to exercise adequately for an ECST?
  • Physiologic Stress Test
  • Find a local Cardiologist in your town
• Are there other tests for CAD that are noninvasive?
• What is the most accurate method of defining CAD?

What is coronary artery disease?

Coronary artery disease (CAD) is arteriosclerosis of the inner lining of the blood vessels that supply blood to the heart. CAD is a common form of heart disease and is a major cause of illness and death. CAD begins when hard cholesterol substances (plaques) are deposited within a coronary artery. (The coronary arteries arise from the aorta, which is adjacent to the heart.) The plaques can cause a tiny clot to form which can obstruct the flow of blood to the heart muscle. Symptoms of CAD include 1) chest pain (angina pectoris) from inadequate blood flow to the heart; 2) heart attack (acute myocardial infarction), from the sudden total blockage of a coronary artery; or 3) sudden death, due to a fatal rhythm disturbance.

What is the purpose of screening tests for CAD?

In many patients, the first symptom of CAD is myocardial infarction or sudden death, with no preceding chest pain as a warning. For this reason, doctors perform screening tests to detect signs of CAD before serious medical events occur. Screening tests are of particular importance for patients with risk factors for CAD. These risk factors include a family history of CAD at relatively young ages, an abnormal serum cholesterol profile, cigarette smoking, elevated blood pressure (hypertension), and diabetes mellitus.

What are common initial screening tests for CAD?

Initial screening for CAD commonly involves stressing the heart under controlled conditions. These stress tests are able to detect the presence of flow-limiting blockages in the coronary arteries, generally in the range of at least a 50% reduction in the diameter of at least one of the three major coronary arteries. There are two basic types of stress tests; those that involve exercising the patient to stress the heart (exercise cardiac stress tests), and those that involve chemically stimulating the heart directly to mimic the stress of exercise (physiologic stress testing). Physiologic stress testing can be used for patients who are unable to exercise.