heart and blood vessel disorders
Chest Pain
Evaluation of Chest Pain
People with chest pain should be evaluated by a doctor. The following information can help people decide when evaluation is needed and help them know what to expect during the evaluation. In people with chest pain or discomfort, certain symptoms and characteristics are cause for concern. They include Crushing or squeezing pain Shortness of breath Sweating Nausea or vomiting Pain in the back, neck, jaw, upper abdomen, or one of the shoulders or arms Light-headedness or fainting Sensation of rapid or irregular heartbeat Although not all causes of chest pain are serious, because some causes are life threatening, the following people should seek care in an emergency department right away: Those with new chest pain (within several days) Those who have a warning sign Those who suspect that a heart attack is occurring (for example, because symptoms resemble a previous heart attack) These people should call emergency services (911) or be taken to an emergency department as quickly as possible. People should not try to drive themselves to the hospital. Chest pain that lasts for seconds (less than 30 seconds) is rarely caused by a heart disorder. People with very brief chest pain need to see a doctor, but emergency services are usually not needed. People who have had chest pain for a longer time (a week or more) should see a doctor as soon as possible, but they do not need to go to the hospital unless they develop warning signs or the pain has steadily been getting worse or coming more often, in which case they should go to the hospital right away. Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What they find during the history and physical examination often suggests a cause of the chest pain and the tests that may need to be done. However, symptoms due to dangerous and not dangerous chest disorders overlap and vary greatly. For example, although a typical heart attack causes dull, crushing chest pain, some people with a heart attack have only mild chest discomfort or complain only of indigestion or arm or shoulder pain (referred pain—see figure). On the other hand, people with indigestion may simply have an upset stomach, and those with shoulder pain may have only sore muscles. Similarly, although the chest is tender when touched in people with musculoskeletal chest wall pain, the chest can also be tender in people who are having a heart attack. Thus, doctors usually do tests on people with chest pain. For adults with sudden chest pain, tests are done to rule out dangerous causes. For most people, initial tests include Measurement of oxygen levels with a sensor placed on a finger (pulse oximetry) Electrocardiography (ECG) Chest x-ray If symptoms suggest an acute coronary syndrome (heart attack or unstable angina) or if no other cause is clear (particularly in people who are at high risk), doctors usually measure levels of substances that indicate heart damage (cardiac markers) in the blood (at least two separate times over a few hours) and do repeated Electrocardiography . If these tests do not show an acute coronary syndrome, doctors often then do a Stress Testing or CT angiography before people go home or within a few days. However, if a newer cardiac marker, called high sensitivity troponin, is used and that test does not show evidence of heart damage, further testing may not be required. For a stress test, ECG or an imaging test (such as If pulmonary embolism is suspected, CT angiography (CT with intravenous contrast) of the lungs or a Chest Imaging is done. If pulmonary embolism is considered only somewhat possible, a blood test to detect clots (D-dimer test) is often done. If this test is negative, pulmonary embolism is unlikely, but if the test is positive, other tests, such as ultrasonography of the legs or CT angiography, are often done. In people who have had chest pain for a long time, immediate threats to life are unlikely. Most doctors initially do only a chest x-ray and then do other tests based on the person's symptoms and examination findings. 