There are many diagnostic procedures available for assessing the health of the heart.  A brief summary the most common ones follows:

Intravascular Ultrasound (IVUS):  One of the most sophisticated of all cardiac procedures, this involves a cardiac catheterization as described below, but with the addition of ultrasound.  A small “sonar” probe is inserted into the arteries of the heart allowing for cross-sectional views of the plaque, and vessel walls.  This is the only test that can visualize soft plaque.  It is considered an invasive test and costs from $2,500 -$5,000.

Cardiac Catheterization:  Also referred to as coronary angiography, this test is the gold standard for demonstrating the occlusions (blockages) or stenoses (narrowings) in the arteries of the heart.  In this procedure, a long wire is inserted into an artery in the groin area and under xray fluoroscopy it is guided to the vessels of the heart.  After placement, a long, thin, flexible tube (catheter) is gently slid over the wire until it reaches the heart.  The guide wire is subsequently withdrawn.  The cardiologist is then able to inject a special dense liquid (called Intravascular Contrast) through the tube to an exact arterial location. This liquid can be seen under xray fluoroscopy, and as it fills the arteries an occlusion or stenosis becomes readily apparent.  The plaque is not usually visualized, but the open area of the vessel (called the lumen) is beautifully demonstrated.

Perhaps the greatest benefit to this procedure is that it can also be used to repair many disease situations.  If a stenosis is found, a special type of catheter with a balloon-tip can be inserted.  When the tip is at the site of the stenosis it can be inflated slightly to expand the artery and restore adequate blood flow to the heart.  To keep this expanded area open, a stent (short, tubular wire cage) can be left behind.  This interventional, or corrective process, is called angioplasty.  The cost of a catheterization procedure, which is an invasive test, is about $2,500-$7,000.

PET Scanning:  (Positron Emission Tomography) This procedure cannot actually visualize the arteries, however, like most other non-invasive tests it can demonstrate deficiencies in function as a result of inadequate blood flow.  In this case, the patient is injected with a fast-decaying radioactive liquid (called an isotope) which is metabolized by the healthy muscle tissue in the heart.  An area with no flow, or dead (infarcted) tissue, does not metabolize the liquid.  The patient is inserted into a device that looks like a CAT scanner.  This unit, called a PET system, acquires 3-Dimensional images of the radioactivity: therefore, the resultant images are those of the healthy cardiac tissue only.  (Infarcted areas are absent.)  This test is relatively non-invasive and costs about $2,500.

Stress Nuclear:  Like the PET scan above, this test utilizes a radioactive liquid which is injected.  Although slightly less sensitive than PET, the nuclear procedure requires a less sophisticated imaging device and less expensive isotope.  Most of these procedures require the patient to be exercised (stressed) prior to imaging.  This can be achieved in different ways, such as the treadmill, the reclined bike, and even drug-induced stress.  The stress causes the arteries to constrict and any blood flow deficiencies (ischemia) to be accentuated.  The patient is also imaged at rest for comparison purposes.  The stress nuclear is relatively non-invasive and costs about $1,500.

Stress Echo:  Also requiring the patient to be imaged at stress, and at rest, this procedure utilizes an ultrasound system.  The ultrasound (sonar) allows for the visualization of heart valve operation and cardiac wall-motions.  If there is a deficiency in the health of an area of the myocardium, due to stenosis or infarction, the wall motion will be affected.  This is a non-invasive test and costs about $1,100.

Stress EKG:  This is the standard test for screening of heart disease.  Requiring only a treadmill and an electrocardiogram (EKG or ECG), the patient is monitored at stress and rest, and the electrical activity (EKG) of the heart is traced.  Relatively inexpensive, this test is excellent at detecting electrical anomalies, but is not very sensitive for detection of atherosclerosis.  This test is non-invasive and costs about $350.

MRI:  Magnetic resonance imaging is a potentially powerful tool for assessing multiple aspects of cardiac function, non-invasively.  In theory, the data from a single MRI procedure could be as useful as a stress EKG, stress nuclear, and stress echo study, combined.  The technology is not yet widely available for cardiac applications, but it is likely to emerge very quickly.