Test for "silent" coronary heart disease (2024)

Some people with coronary heart disease have no symptoms of the disease.

Heart disease is the leading cause of death in the United States. Coronary artery disease refers to heart diseases that result from the buildup ofbrochure(accumulation of cholesterol, calcium and other materials) in the coronary arteryarteries(blood vessels) that supply blood to the heart.

Common symptoms of coronary artery disease include chest pain and difficulty breathing, especially with activity. Many people with coronary heart disease have no symptoms and therefore do not know that they have problems with their heart. As a result, they don't take the right medicine that can help prevent a heart attack, stroke or death. In these people without symptoms, testing for coronary heart disease may still be useful.

As a general rule, only people at high risk for heart disease should be tested for this and people without symptoms. These people are said to be at high cardiovascular risk. It is important to know which people are in this risk category. Several risk assessment tools are available to help doctors decide who to test.

Examples of some risk assessment tools include the Framingham Risk Score, Pooled Cohort Equations, and Systematic Coronary Risk Evaluation (SCORE). These tools take into account risk factors for heart disease, such as older age, smoking, high blood pressure, being overweight or obese, diabetes, high cholesterol and a family history of heart disease. They also help doctors decide who should be treated with certain medications, such as statins for high cholesterol.

In people without symptoms, basic screening for coronary heart disease includes checking for the above risk factors as part of a general medical examination.

But there are also several other types of tests that haven't been studied enough to say they're useful for everyone. Your doctor can advise whether these tests are suitable for you. They contain

• Blood tests:High levels of high-sensitivity C-reactive protein or hom*ocysteine ​​in the blood may indicate a higher cardiovascular risk in a select group of people.

• Electrocardiogram:An electrocardiogram (ECG) shows the electrical activity of the heart. For people without symptoms, an exercise ECG (treadmill stress test) is generally not recommended for screening for coronary heart disease.

• Imaging tests:Imaging tests look for signs of plaque buildup in the arteries. Some types of imaging tests used to screen for heart disease are ultrasound and computed tomography (CT) scanning.

Ultrasound can be used to look at the heart as a whole as well as at larger arteries in the body (such as the carotid artery in the neck and the aorta in the abdomen). But the small arteries in the heart, which cause heart attacks when they become blocked, cannot be seen on ultrasound..To see these smaller arteries, doctors sometimes recommend acoronary CTscan that looks specifically at the heart arteries. This type of CT scan can estimate and calculate the amount of plaque in the arteries of the heartcoronararterie calciumscore. This score may be useful in predicting cardiovascular risk in some people, as described in the Diagnostic Test Interpretation article in the August 27, 2014 issue ofJAMA.

The JAMA Patient Page is a public service ofJAMA. The information and recommendations on this page are appropriate in most cases, but are not a substitute for a medical diagnosis. For specific information regarding your personal medical condition,JAMArecommend that you consult your doctor. This page may be photocopied non-commercially by physicians and other healthcare professionals for sharing with patients. To purchase bulk prints, call 312/464-0776.

Bron:WallaceML et al. Screening strategies for cardiovascular disease in asymptomatic adults.First concern.2014;41(2):371-397.

Topic: Cardiovascular diseases