Coronary artery disease is usually caused by the build up of a fatty substance called plaque within the wall of the coronary arteries. The scientific name for this substance is "atheroma", which comes from the Greek for "gruel" or "porridge"!

This build up within the walls can over time can cause a reduction in blood flow down the artery. In some patients this can get to quite an advanced stage before symptoms arise. The usual symptoms which patients feel are chest pain or tightness, or breathlessness. It is important to understand, however, that this build up usually occurs over many years, and there is a long "pre-clinical" stage where there is a build up of atheroma but no symptoms. With this build up atheroma comes a risk of heart attacks; most heart attacks occur in patients who have not previously had symptoms. This is why it is so important to understand your heart health, and look after yourself with a sensible diet, plenty of exercise and, when appropriate, preventative medications.

To investigate this further, a number of tests are available. Each has advantages and disadvantages, and your G.P. or cardiologist will be able to discuss these with you.
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Exercise tolerance testing.

With an exercise test, you will have an ECG performed as you walk on a treadmill. This will allow the cardiologist to watch how you, and the tracing of your heart, responds to exercise.
CT calcium score and coronary angiography

It is possible to look at the coronary arteries using the non-invasive method of CT scanning. The combination of a calcium score and the CT coronary angiogram will allow the cardiologist to review your coronary arteries, and advise you if treatments are indicated.

CT scans are increasingly used to look at the coronary arteries early in the course of a patient's care, as it gives not only good diagnostic information but also good prognostic information (ie what is the risk of heart attack).
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Stress echocardiogram.

With this test, the cardiologist will get your heart to pump faster either by exercise, or by using a drug to get the heart going. Once your heart is working hard, an echocardiogram (ultrasound of the heart) will be recorded and compared to one at rest.

If there is a problem with the blood supply to the heart, the muscle of the heat will not respond normally to the increased demands of the exercise.
Coronary angiography.

With an invasive or percutaneous angiogram, a small tube called a catheter is passed through an artery (usually in the wrist) to your heart. Once there, dye is injected and X-ray images taken to look at the blood supply to your heart. The main advantage of this technique is that a stent can be placed at the same time, if deemed appropriate, so that this can be a diagnostic and treatment modality at the same time.

The downside is that this is, of course, an invasive test and this must always be considered when discussing angiography. The risk of a major problem is extremely low, but not 0%.
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