Other conditions that indicate coronary artery disease
Does my physical exam suggest that I have coronary artery disease?
Doctors can diagnose certain heart conditions with a physical exam by carefully observing the visual appearance of the body and listening to sounds the body makes. Coronary artery disease (CAD), unfortunately, is not one of these conditions. Although CAD may cause symptoms, it does not typically cause physical signs that your doctor can detect during a physical exam. Because there is no way to directly examine your coronary arteries during a standard physical exam, your doctor cannot find any direct evidence of CAD simply by examining you.
Instead, your doctor will need to look for evidence of other conditions that often go hand-in-hand with CAD. This evidence can indirectly provide evidence that you have CAD, but it cannot confirm whether you have CAD. During a physical exam, your doctor may discover evidence of atherosclerosis, identify risk factors for CAD, and find other clues that make it more likely that you have CAD.
What are some important physical signs?
Conditions that may be related to CAD include:
- Atherosclerosis in other arteries.
- High cholesterol .
- High blood pressure .
- Heart failure .
- Impotence (erectile dysfunction).
- Diabetes .
During your physical exam, your doctor will likely look for evidence of these conditions, which increase the chances that you also have CAD.
Do I have atherosclerosis in other arteries?
Hardening and narrowing (atherosclerosis) tends to occur in all of your arteries, not just your coronary arteries. If you have atherosclerosis in one of your arteries, there is a good chance that you have atherosclerosis in other blood vessels throughout your body.
Coronary arteries are located on your heart and can't be directly examined. However, your doctor can evaluate other arteries in your body by listening with a stethoscope or ultrasound for abnormal sounds within the artery called bruits. Your doctor can also feel your pulses to check blood flow and feel for swelling in large arteries. Finding evidence of atherosclerosis in these arteries doesn't prove that you have atherosclerosis in your coronary arteries, but it strongly suggests that you might.
The table below lists the other arteries that your doctor can examine to look for evidence of atherosclerosis.
Artery that supplies blood to:
Evidence of atherosclerosis
What causes it
|Your brain (carotid artery)||A rushing noise in your carotid artery (carotid bruit) due to turbulent blood flow||Atherosclerosis, which narrows the artery|
|Your abdomen (abdominal aorta)||Swelling of your abdominal aorta (aortic aneurysm)||Atherosclerosis in your aorta|
|Your legs (femoral artery)||A rushing noise in your femoral artery (femoral bruit) due to turbulent blood flow||Atherosclerosis, which narrows the artery|
|Difficulty feeling the flow of blood in your feet (weak pulse)||Atherosclerosis, which narrows the artery and decreases blood flow, making your pulse feel weaker|
What are some physical signs of high cholesterol?
In most cases, the only way to know for sure whether you have high cholesterol is to get a blood test that measures the cholesterol in your blood.
Some people with extremely high cholesterol sometimes get deposits of cholesterol in their skin that look like small, yellow bumps and tend to appear on the skin that covers the elbows, knees, hands, and feet. The medical name for these cholesterol bumps is xanthomas.
Some people also get whitish-yellow cholesterol bumps on their eyelids. These are called xanthelasmas. People who have xanthelasmas may have high cholesterol, although many people who have these deposits on their eyelids do not have high cholesterol.
Do I have high blood pressure?
Your doctor will check your blood pressure during your physical exam to find out whether you have high blood pressure (hypertension). Hypertension is considered a risk factor for CAD.
Where else might my doctor look for signs of CAD?
Using a special light, called an ophthalmoscope, your doctor can see the arteries in the back of your eyes. Your doctor may find evidence of hypertension, diabetes, and sometimes high cholesterol when examining your eyes, all of which are risk factors for CAD.
An arcus senilis is a whitish or pale ring around the colored portion of your eye (cornea). This whitish, pale color may appear as a crescent under the cornea or may completely encircle it. The ring is normal in older people, but in people younger than age 40, it is considered further evidence of CAD. It is not clear what causes the arcus, but it may be due to high cholesterol.
Doctors have noted that many people with CAD have creases in their earlobes. Like the arcus senilis described above, theses creases are more common in people younger than 40 who have CAD. No one knows what causes the creases nor why they should be associated with CAD.