How is cardiovascular disease diagnosed?

How do you diagnose cardiovascular disease? There are lots of different ways. You know, the main thing is that there's two elements to this, I guess. You could say the one thing is picking up patients who have symptoms. So if someone has a symptom of breathlessness, of palpitations, of angina, of any form of chest pain, then they should immediately be taken a step further in terms of thinking about how we make that diagnosis. and there are different ways from there in how to make the diagnosis. The first screening step may be an ECG if it's something that's not barn door angina. The first step may be an ECG. Another investigative step may be an echocardiogram that looks at the overall structure and function of the heart. It would tell you if you've already had a heart attack, but may not tell you if you have a severe narrowing in an artery. The real gold standard test at the moment, or maybe not gold standard, but the real test of choice at the moment is a CT coronary angiogram, where essentially you go into hospital, you have a cannula put in, they inject dye into the cannula, they may give you medications to slow the heart rate down, and then we take pictures of the heart through the CT scanner. We can light up the arteries of the heart specifically, and look for small areas of plaque or severe areas of narrowing. So that's, you know, the test of choice at the moment is a CT coronary angiogram. That really gives you an idea of what's in the arteries. The only problem with that is that you may see, let's say, a moderate narrowing. So let's say you have a 65 to 75 percent narrowing. You don't know what scale, what side of the scale that sits on. So if it's over 70 percent, it might be considered severe, or if it's under, it might be considered moderate. So you may not know for sure if that's causing a serious problem or not. And then a functional test, like a stress echo or stress MRI, may give you that information because then you stress the heart and you see the effects on the muscle. So you don't necessarily see the arteries themselves with the stress test, you see the effect of the narrowing on the muscle. So when the muscle isn't getting the blood supply you see the effects of that with an MRI or stress echo. And you know we used to use exercise treadmill tests to diagnose that because of course you can see ECG changes sometimes. That's not necessarily as sensitive or specific to pick out these problems. Having said that when I do have patients with coronary disease, sometimes we do put them on a treadmill just to see what their exercise tolerance is. And interestingly, I had a chat the other day who I did the CT scan, had severe coronary disease. I put them on the treadmill just to see what their exercise tolerance was. He had a really good exercise tolerance and had no chest pain despite having severe changes on his ECG for the stress test. So, you know, testament to the fact that you can have significant coronary disease without having necessarily chest pain as you're presenting things. But CT cardiogram or stress test, some form of stress test is the best way to make that diagnosis. Things like checking your cholesterol is obviously additive to that because it gives you a target of what to drive down.