Your doctor will diagnose coronary heart disease based on your symptoms, your medical and family history, your risk factors, and the results from tests and procedures.

Because women and their doctors may not recognize coronary heart disease symptoms that are different from men’s, women may not be diagnosed and treated as quickly as men. It is important to seek care right away if you have symptoms of coronary heart disease:

• Medical history

Your doctor will ask about your eating and physical activity habits, your medical history, your family history, and risk factors for coronary heart disease. Your doctor may ask whether you have any other signs or symptoms. This information can help your doctor determine whether you have complications or other conditions that may cause coronary heart disease.

• Diagnostic tests and procedures

To diagnose coronary heart disease, your doctor may order some of the following tests:

• Blood tests to check the levels of cholesterol, triglycerides, sugar, lipoproteins, or proteins, such as C-reactive protein, that are a sign of inflammation.

• Electrocardiogram (EKG or ECG) to determine whether the heart’s rhythm is steady or irregular. An EKG also records the strength and timing of electrical signals as they pass through the heart.

• Coronary calcium scan to measure the amount of calcium in the walls of your coronary arteries. A buildup of calcium can be a sign of atherosclerosis, coronary artery disease, or coronary microvascular disease. This test is a type of cardiac CT scan. Coronary calcium scans can also help assess coronary heart disease risk for people who smoke or for people who do not have heart symptoms.

• Stress tests to check how your heart works during physical stress. During stress testing, you walk or run on a treadmill or pedal a stationary bike to make your heart work hard and beat fast. If you have a medical problem that prevents you from exercising, your doctor may give you medicine to make your heart work hard, as it would during exercise. To detect reduced blood flow to your heart muscle, while you exercise you will be monitored by ECG and possibly an echocardiogram or a CT scan.

• Cardiac MRI (magnetic resonance imaging) to detect tissue damage or problems with blood flow in the heart or coronary arteries. It can help your doctor diagnose a coronary microvascular disease or nonobstructive or obstructive coronary artery disease. Cardiac MRI can help explain results from other imaging tests such as chest X-rays and CT scans.

• Cardiac positron emission tomography (PET) scanning to assess blood flow through the small coronary blood vessels and into the heart tissues. This is a type of nuclear heart scan that can diagnose coronary microvascular disease.

• Coronary angiography to show the insides of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. This procedure is often used if other tests show that you are likely to have coronary artery disease. To diagnose coronary microvascular disease, your doctor will use coronary angiography with a guidewire technology. A guidewire with sensors is inserted into the heart’s arteries. The sensors measure how easily blood flows through the small vessels. Usually, measurements are done before and after giving you medicine to enhance blood flow in your heart.

• Coronary computed tomographic angiography shows the insides of your coronary arteries rather than an invasive cardiac catheterization. It is a noninvasive imaging test using CT scanning.

If you have coronary heart disease risk factors, your doctor may recommend diagnostic tests even if you do not have symptoms.

Nonobstructive coronary artery disease and coronary microvascular disease can be missed because patients or doctors may not recognize the warning signs. Diagnosing these types often requires more invasive tests or specialized tests, such as cardiac PET scans, that are not widely available.