Diagnosis
Chest pain doesn’t always signal a heart attack. But that’s what healthcare providers in the emergency room usually test for first because it’s potentially the most immediate threat to your life. They also may check for life-threatening lung conditions — such as a collapsed lung or a blood clot in the lung.
Immediate tests
Some of the first tests a healthcare provider may order when diagnosing the cause of chest pain include:
- Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays or prints the test results. An ECG can show if the heart is beating too fast or too slowly. An ECG can help show if you have had or are having a heart attack.
- Blood tests. Specific heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins.
- Chest X-ray. A chest X-ray shows the condition of the lungs, the size and shape of the heart, and the major blood vessels. It can also reveal lung problems such as pneumonia or a collapsed lung.
- Computerized tomography (CT) scan. CT scans can spot a blood clot in the lung or find an aortic dissection.
Follow-up testing
Depending on the results from the first tests for chest pain, you may need more testing, which may include:
- Echocardiogram. Sound waves are used to create videos of the heart in motion. A more detailed echocardiogram may sometimes be done to get better heart pictures. A small device may be passed down the throat to obtain better views of different parts of the heart.
- Computerized tomography (CT) scan. Different CT scans can be used to check the heart arteries for blockages. A CT coronary angiogram can also be done with dye to check the heart and lung arteries for blockages and other problems.
- Stress tests. These tests often involve walking on a treadmill or riding a stationary bike while watching the heart rhythm. Exercise tests help show how the heart reacts to exercise. If you can’t exercise, you might be given medicines that affect the heart like exercise does.
- Coronary catheterization. This test helps healthcare providers see blockages in the heart arteries. A long, thin, flexible tube is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. The dye flows through the tube to the heart’s arteries. The dye helps the arteries show up more clearly on X-ray images and videos.
Treatment
Chest pain treatment varies depending on what’s causing the pain.
Medications
Medicines used to treat some of the most common causes of chest pain include:
- Artery relaxers. Nitroglycerin — usually taken as a tablet under the tongue — relaxes heart arteries so blood can flow more quickly through the narrowed spaces. Some blood pressure medicines also relax and widen blood vessels.
- Aspirin. If healthcare providers think your chest pain is related to your heart, you’ll likely be given aspirin.
- Clot-busting drugs, also called thrombolytics, are used to dissolve clots that block blood from reaching the heart muscle. If you have a heart attack, you may receive these medicines.
- Blood thinners. If you have a clot in an artery going to your heart or lungs, you’ll likely be given medicines to prevent more clots from forming.
- Acid-reducing medicines. If chest pain is caused by stomach acid splashing into the esophagus, a healthcare provider may suggest these medicines. They reduce the amount of acid in the stomach.
- Antidepressants. If you’re having panic attacks, your healthcare provider may prescribe antidepressants to help control symptoms. Talk therapy, such as cognitive behavioral therapy, also might be recommended.
