John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
If you have any symptoms of chest pain, especially if the pain is new, call your doctor or 911.
It may be best to call 911 for emergency transport to the nearest hospital emergency department. Do not try to drive yourself.
Because so many causes of chest pain often mimic a heart attack or other life-threatening illnesses, it is best to seek medical attention as quickly as possible.
If you suspect that you may be having a heart attack or other life-threatening chest pain, call 911 and go to the nearest hospital emergency department. Do not try to drive yourself.
If you are having a heart attack, time is muscle. The longer you wait to receive evaluation and treatment, the more heart muscle is damaged.
If there is something serious going on that is causing your chest pain, doctors can choose from many effective early interventions to reduce your chances of death or severe illness. These treatments can have a positive effect on the long-term quality of your life.
What if it turns out not to be a heart attack or other life-threatening event?
You won't know until the medical professionals at the hospital check out the cause of your chest pain. Give yourself that peace of mind.
If your chest pain is not life-threatening, you should not feel embarrassed or that you "wasted everyone's time." Whatever the outcome, you always make the correct choice by going to the nearest hospital emergency department.
Chest pain, regardless of whether it is caused by a life-threatening condition, needs to be evaluated by a medical professional. Be reassured that you are making the right decision and feel comfortable seeking emergency care whenever you experience chest pain.
Exams and Tests
In the hospital emergency department, the healthcare providers use three basic procedures to decide if
a patient is having a heart attack.
The first is the symptoms reported by the patient.
The second is an electrocardiogram
(ECG or EKG), an electrical tracing of the heart's activity. On the ECG, it
may be possible to tell which vessels in the heart are blocked or narrowed.
The third is measurement of enzymes produced by the heart muscle cells when they do not receive enough oxygen. These enzymes are detectable with blood tests and are called cardiac enzymes.
Angina is diagnosed by the same methods doctors use to diagnose heart attacks.
In angina, the test results reveal no permanent
damage to the heart.
The diagnosis is made only after the possibility of a
heart attack has been ruled out, usually by negative results on three sets of
cardiac enzyme tests.
Although the ECG may show abnormalities, these
changes are often reversible.
Another way to diagnose angina is the stress test:
these tests monitor your ECG during exercise or other stress to identify
blockages in blood vessels to the heart.
Cardiac catheterization is used to identify
blockages. This is a special type of x-ray (angiography or arteriography) that uses a harmless dye to highlight blockages or other abnormalities in blood vessels.
The diagnosis of aortic dissection is based on the symptoms the patient describes,
chest x-ray, and other special imaging tests.
On a chest x-ray, the aorta will have an abnormal
contour or appear widened.
Transesophageal echocardiography is a specialized ultrasound of the heart in which a probe
is inserted into the esophagus. The technique is performed under sedation or
The dissection may be identified very accurately by a CT scan of the chest or angiography.
The diagnosis of pulmonary embolism is made from a variety of sources.
Description of the patient's symptoms and results of
ECG and chest x-ray all may contribute to the diagnosis, but are not
The patient will be asked if they have had any symptoms of a
blood clot in the leg.
The healthcare provider may draw blood drawn from the
patient's artery to check the levels of oxygen and other gases. Abnormalities
in blood gases indicate a problem in the lungs that is preventing the patient
from getting enough oxygen.
A ventilation-perfusion scan (V/Q scan) compares
blood flow to oxygen intake in different segments of the lung. An irregularity
in just one segment can indicate an embolism.
A CT scan of the lungs is another way to determine if a patient has a pulmonary embolus. It may be done instead of the V/Q scan.
Spontaneous pneumothorax is diagnosed by physical exam and chest x-ray. A CT scan may be helpful in locating a small pneumothorax.
Perforated viscus usually can be identified by a chest x-ray with the patient standing upright or an abdominal x-ray lying on the left side.
X-rays in these
positions allow air to rise to the diaphragm, where it can be detected.
The symptoms and the results of the physical exam and other lab tests also assist in diagnosis.
Acute pericarditis is usually diagnosed by the patient's symptoms, serial ECGs, and echocardiography. Certain lab tests may be helpful in determining the cause.
Pneumonia is diagnosed by the patient's symptoms and medical history, physical examination, and chest x-ray.
Disorders of the esophagus causing chest pain are diagnosed by a process of elimination. The diagnosis is made on the basis of
the patient's symptoms and medical history, after ruling out cardiac causes and observing whether
the patient experiences pain relief from antacids.