Heart Attack

Diagnosis

Diagnosing a heart attack can occur at several points: in the ambulance on the way to the hospital, in a hospital’s emergency room, or after a heart attack has already occurred. Whoever treats you at any stage will use symptom evaluation and tests to diagnose a heart attack.

Tests

• Electrocardiogram (ECG/EKG) – This test records the electrical activity of your heart. It can detect abnormalities in your heart's rhythm and specific patterns that suggest portions of the heart may not get enough blood flow. An ECG can help doctors detect heart muscle damage from a heart attack. ECG is a valuable tool to detect heart attacks early and determine the urgency of going to cardiac catheterization to open the blockage in your heart.
• Echocardiogram (echo, Doppler, heart ultrasound) – This noninvasive test uses sound waves to picture your heart muscles, valves, and blood flow in motion. It is crucial to assess whether all areas of the heart are contracting well. If you have a heart attack, generally, the affected area of your heart won’t pump as well as the rest of your heart, which could affect the function of your heart valve.
• Blood tests – Certain substances in the blood can help doctors identify if a patient has had a heart attack. When the heart muscle is damaged, it releases particular enzymes and proteins into the bloodstream, such as the protein troponin. Cardiac enzyme tests such as creatinine kinase (CK), CK-MB, and troponin are other blood tests used to assess for a heart attack.
• Cardiac catheterization/angiogram (left heart catheterization) ­– This test involves an X-ray dye being injected into your heart's arteries to see the blood flow to the heart muscle and how well the heart is pumping. If a blockage has been detected, the treatment team can decide whether the heart attack would be best treated with angioplasty and stenting or cardiac artery bypass graft surgery (CABG).
• Intravascular ultrasound (IVUS) – This test can be performed during cardiac catheterization to assess the lining of an artery for blockages, choose the right size for the stent, and confirm that the stent is well positioned.
• Optical coherence tomography (OCT) – This technique is performed with cardiac catheterization to assess the lining of an artery for blockages at a very high resolution.
• Fractional flow reserve (FFR) – This technique assesses the significance of a blockage in a heart artery by measuring the pressures before and after the blockage.