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Ischemic heart disease can be diagnosed in different settings like when the patient presents with acute heart attack or acute onset chest pain or when patient presents with lore stable chest pain on exertion or other symptoms suggestive of myocardial ischemia. The tests which are necessary are usually an electrocardiogram and echocardiogram and injury markers like troponin I in more chronic settings we diagnose ischemic heart disease based on some type of functional cardiac imaging, which can be a simple treadmill testing or thallium nuclear testing with either physical stress like walking on the treadmill or a chemical stress like adenosine or dobutamine. Ischemic heart disease can also be diagnosed based on echocardiogram showing regional warm motion abnormalities on a chronic basis or magnetic resolution imaging or MRI of the heart which may show infarcted heart muscle and confirmatory diagnosis of ischemic heart disease, is usually by an angiogram. A CT coronary angiogram can be used although it can sometimes miss or over read. Gold standard for diagnosing coronary artery disease is standard coronary angiography.