The patient’s blood sample is sometimes tested to see the presence of certain enzymes which leak out of the heart with damage to the heart muscles. Blood tests are minimally invasive tests, which require a blood sample of the patient. The test takes about 5 minutes and the patient is not kept under observation.

A chest X-ray is a non-invasive imaging test of the heart and lungs. An X-ray is taken to have an overview of the heart and lungs, and to rule out other medical conditions which might mimic angina. An X-ray takes about 5 minutes, which does not require the patient to be either hospitalized or be kept under observation. 

This is a fairly new addition to the earlier diagnostic tests, which helps to identify coronary artery disease. During the test, the patient is intravenously injected with a contrast material (dye), and the imaging of the coronary arteries is recorded through a special CT scanner. This test helps in examining the coronary arteries for any blockage or reduced blood flow. CT coronary angiography is generally a safe test, and takes about 15 to 20 minutes for completion. The patient is not kept under observation.

This is a minimally invasive imaging test in which the patient is intravenously injected with a nuclear agent (thallium), usually during the normal exercise stress test. Thallium mixes in with the patient’s blood which allows nuclear imaging of the blood flow during stress through a scanner. A reduced blood flow in a certain area during exercise, which is otherwise normal at rest, can be differentiated through this test. The test takes about 30 minutes to complete. The patient is not kept under observation before or after the test.

A stress EKG is a non-invasive imaging test, performed on patients with normal resting EKG. In this procedure, stress is generated through exercise with increasing difficulty, while the electrical impulses of the heart are recorded through EKG leads. A chest pain during the test is a result of reduced oxygen supply to the heart, which can be correlated with EKG changes. If the pain disappears with rest, it directly points towards angina. The test takes about 15 to 20 minutes and the patient is not kept under observation.

Echocardiography refers to ultrasound imaging of the heart. Stress echocardiography is a highly accurate, non-invasive test to identify the working of heart muscles. When a coronary artery narrows, the subjected muscle does not contract as well as other heart muscles. The patient is subjected to physical exercise (treadmill or stationary cycling) to generate stress, while sound waves are induced through the tissues to reflect the images of the heart. Stress echocardiography is 80% to 85% accurate and takes about 15 to 30 minutes to complete. There is no need to keep the patient under observation.

Cardiac catheterization with coronary arteriography is a minimally invasive procedure, conducted to examine the coronary arteries. The patient is first sedated with general anesthesia. Long, narrow, flexible tubes (catheters) are then advanced into the opening of coronary arteries through a small incision. The practitioner then injects a contrast material (dye) through the catheter, into the arteries, and an X-ray video is recorded. This is an excellent diagnosis to identify possible narrowing of the coronary arteries, which might have resulted in a reduced blood supply to the heart. The test can take from 20 minutes to over an hour, depending upon the skill of the practitioner. The patient is usually kept under overnight observation after the test. 

Electrocardiogram is a non-invasive sonogram of heart, performed to check for abnormal heart rate and arrhythmia (abnormal heart rhythm). In this test, the patient is made to lie down and some gel is applied on the upper chest region. ECG leads are connected to six predefined positions and the electrical impulses of the heart are recorded, transmitted through the leads. The patient is not kept under observation before or after the test, which usually takes about 15 minutes to complete. This test is conducted to check for reduced blood supply through the heart which might have caused angina.

A thorough assessment of the symptoms conducted by a physician (preferably a neurosurgeon) can provide the building blocks of further diagnosis. Symptoms of angina can be stable (acute), or unstable (medical emergency). Hence, a physical examination is the first step of diagnosis. In case unstable angina is suspected, the patient is kept in intensive care throughout.