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Tests and diagnosis
By Mayo Clinic staffAt the emergency room or chest pain center — some large hospitals designate areas just for the evaluation of chest pain — you'll probably have your blood pressure, pulse and temperature checked right away. In addition, the doctor will ask a number of questions about your chest pain.
Chest pain doesn't always signal a heart attack. But that's what emergency room doctors will test for first because it's potentially the most immediate threat to your life. They may also check for an aortic dissection or life-threatening lung conditions — such as pulmonary embolism or a collapsed lung (pneumothorax) — that can cause chest pain.
Tests you may have to determine the cause of your chest pain include:
- Electrocardiogram (ECG). This test can help doctors diagnose a heart attack as well as other heart problems. It records the electrical activity of your heart through electrodes attached to your skin. Heart rate and rhythm and the electrical impulses going through your heart are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
- Blood tests. Your doctor may order blood tests to check for increased levels of certain enzymes normally found in heart muscle. Damage to heart cells from a heart attack may allow these enzymes to leak, over a period of hours, into your blood.
- Chest X-ray. An X-ray of your chest allows doctors to check the condition of your lungs and the size and shape of your heart and major blood vessels. Doctors can also use a chest X-ray to check for tumors in the chest and to look for lung problems that can cause chest pain, such as pneumonia or pneumothorax.
- Stress tests. These measure how your heart and blood vessels respond to exertion, which may indicate if your pain is related to your heart. There are many kinds of stress tests. You may be asked to walk on a treadmill or pedal a stationary bike while hooked up to an ECG. Or you may be given a drug intravenously to stimulate your heart in a way similar to exercise. Stress tests may be combined with imaging of the heart using ultrasound (echocardiography) or radioactive material (nuclear scan).
- Echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors identify heart problems.
- Coronary catheterization (angiogram). This test helps doctors identify individual arteries to your heart that may be narrowed or blocked. A liquid dye is injected into the arteries of your heart through a catheter — a long, thin tube that's fed through an artery, usually in your groin, to arteries in your heart. As the dye fills your arteries, they become visible on X-ray and video.
- Computerized tomography (including CT scan, CT coronary calcification scan or CT coronary angiogram). Different types of CT scans can be used to check your heart arteries for signs of calcium, which indicate that atherosclerotic plaques may be accumulating and blocking arteries supplying your heart. CT scans can also be done with dye to look directly at your heart arteries.
- Magnetic resonance imaging (MRI). MRI is an imaging technique that uses magnetic fields and radio waves to create cross-sectional images of your body. MRI of the heart is sometimes done to look for evidence of heart damage or inflammation (myocarditis).
- Endoscopy. In this test a thin, flexible instrument attached to a camera is passed down your throat, allowing doctors to view your esophagus and stomach and check for gastroesophageal problems that can cause chest pain.
Many types of chest pain may at first seem related to heart problems. But often, after careful evaluation, doctors can distinguish the symptoms of noncardiac chest pain from the pain caused by a heart condition.
References
- Meisel JL. Diagnostic approach to chest pain in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 20, 2009.
- Cannon CP, et al. Approach to the patient with chest pain. In: Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50052-2&uniq=159657875&isbn=978-1-4160-4106-1&sid=887271424. Accessed Sept. 20, 2009.
- Talley NJ. Functional gastrointestinal disorders: Irritable bowel syndrome, dyspepsia, and noncardiac chest pain. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/159657875-6/887271424/1492/531.html#4-u1.0-B978-1-4160-2805-5..50144-0--cesec86_5963. Accessed Sept. 20, 2009.
- What is angina? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html. Accessed Sept. 20, 2009.
- What is a heart attack? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_WhatIs.html. Accessed Sept. 20, 2009.
- Shingles disease: Questions and answers (herpes zoster). Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/shingles/dis-faqs.htm. Accessed Sept. 20, 2009.
- Mercier LR. Costochondritis. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/160691114-3/889462700/2088/162.html#4-u1.0-B978-0-323-05609-0..00012-5--sc0235_3245. Accessed Sept. 20, 2009.
- What are pleurisy and other disorders of the pleura. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_treatments.html. Accessed Sept. 20, 2009.
- Ferri FF. Angina pectoris. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/160691114-8/889471687/2088/48.html#4-u1.0-B978-0-323-05609-0..00010-1--s4220_886. Accessed Sept. 20, 2009.
- Heart attack, stroke and cardiac arrest warning signs. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3053. Accessed Sept. 20, 2009.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 25, 2009.
