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Diagnosis of Heart Disease

Diagnosis of ischaemic heart disease is made by the physician by carefully questioning the patient and eliciting detailed information on factors such as the history of his illness; family history; the ages and causes of death of parents, brothers and sisters ( if deceased); his eating smoking and drinking habits; his hobbies, sports and games that he plays; his social life; nature of life at home and at work and his sex life. A detailed physical examination is carried out, blood for relevant tests taken, urine examined and a routine electrocardiogram taken.

It must be admitted that most of the diagnoses of ischaemic heart disease are made either by a creful study of the patient’s history or by the electrocardiogram, aided by other laboratory investigations. Physical examination, i.e., an examination with the hands and the stethoscope, has a relatively minor role to play. Special investigations, like coronary angiography, are done in selected cases.

Doctor, why do I, as a layman, need to know about diagnostic tests?
Patients or their spouses sometimes feel very upset over trivial changes in the blood chemistry or in the electrocardiographic patterns. Savour the following sample questions:

Doctor, my blood cholesterol level was 200 mg. it has now shot up to 220 mg. Am I in imminent danger of a heart attack?
My husband went to a party yesterday, and against your advice, he ate an egg. How much harm will I do to him?
Doctor, you say my ECG is normal. Does this mean that my chest pain is not angina?

You will appreciate the first two questions betray unnecessary alarm, while the third question betrays ignorance, which may lead to inaction. Some familiarity with the diagnostic tests will take the sting out of them, so that unnecessary fears would not crop up in the mind, nor blissful ignorance allowed to delay proper action.

What do we aim to find through these tests?
Diagnostic tests are directed toward finding:

evidence of a fresh or previous heart attack;
evidence of reduced blood supply (ischaemia) to the heart,
disturbances in the heart rhythm;
evidence of coronary artery obstruction and its localization; and
liability to develop ischaemic heart disease.

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