Diagnosis

Chest pain doesn't always signal a heart attack. But that's what health care 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 health care 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. Certain 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. An X-ray of the chest shows the condition of the lungs and the size and shape of the heart and major blood vessels. A chest X-ray also can 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. Sometimes, a more detailed echocardiogram may be done to get better pictures of the heart. A small device may be passed down the throat to obtain better views of different parts of the heart.
  • Computerized tomography (CT) scan. Different types of CT scans can be used to check the heart arteries for blockages. A CT coronary angiogram also can 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 the heart rhythm is watched. 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 health care 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. Dye flows through the tube to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

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 easily through the narrowed spaces. Some blood pressure medicines also relax and widen blood vessels.
  • Aspirin. If health care providers think that your chest pain is related to your heart, you'll likely be given aspirin.
  • Clot-busting drugs, also called thrombolytics. If you are having a heart attack, you may receive these medicines. These work to dissolve the clot that is blocking blood from reaching the heart muscle.
  • 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 health care provider may suggest these medicines. They reduce the amount of acid in the stomach.
  • Antidepressants. If you're having panic attacks, your health care provider may prescribe antidepressants to help control symptoms. Talk therapy, such as cognitive behavioral therapy, also might be recommended.

Surgical and other procedures

Other treatments for some of the most dangerous causes of chest pain include:

  • Angioplasty and stent placement. This treatment helps remove a blockage in an artery going to the heart. The health care provider inserts a thin tube with a balloon on the end into a large blood vessel, usually in the groin. The provider guides the tube to the blockage. The balloon expands. This widens the artery. The balloon is deflated and removed with the tube. A small wire mesh tube called a stent is often placed in the artery to keep it open.
  • Coronary artery bypass surgery. This type of open-heart surgery creates a new pathway for blood to flow around a blockage in the heart. The surgeon takes a blood vessel from another part of the body and uses it to create the new pathway.
  • Emergency repair surgery. You may need emergency heart surgery to repair a ruptured aorta, also called an aortic dissection. It's a life-threatening condition.
  • Lung reinflation. If you have a collapsed lung, a health care provider may insert a tube in the chest to expand the lung.

Preparing for your appointment

If you're having severe chest pain or new or unexplained chest pain or pressure that lasts more than a few moments, call 911 or emergency medical services.

Don't waste any time for fear of embarrassment if it's not a heart attack. Even if there's another cause for your chest pain, you need to be seen right away.

What you can do

Share the following information with the emergency care providers, if possible:

  • Symptoms. Describe your symptoms in detail. Note when they started and anything that makes the pain better or worse.
  • Medical history. Tell your providers whether you've had chest pain before and what caused it. Tell them whether you or any close family members have a history of heart disease or diabetes.
  • Medicines. Having a list of all the medicines and supplements you regularly take helps emergency care providers. You might want to prepare such a list in advance to carry in your wallet or purse.

Once you're at the hospital for chest pain, it's likely that you'll be examined quickly. Based on results from blood tests and a heart monitor, your health care provider may be able to quickly determine if you are having a heart attack — or give you another reason for your symptoms. You or your family may have many questions. If you haven't received the following information, you may want to ask:

  • What's the most likely cause of my chest pain?
  • Are there other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • Do I need to stay in the hospital?
  • What treatments do I need right now?
  • Are there any risks associated with these treatments?
  • What are the next steps in my diagnosis and treatment?
  • I have other medical conditions. How might that affect my treatment?
  • Do I need to follow any restrictions after returning home?
  • Should I see a specialist?

Don't hesitate to ask more questions.

What to expect from the doctor

A health care provider who sees you for chest pain may ask:

  • When did your symptoms start? Have they gotten worse over time?
  • Does your pain spread to any other parts of your body?
  • What words would you use to describe your pain?
  • Do you have trouble breathing, dizziness, lightheadedness or vomiting?
  • Do you have high blood pressure? If so, do you take medicine for it?
  • Do you or did you smoke? How much?
  • Do you use alcohol or caffeine? How much?
  • Do you use illegal drugs, such as cocaine?
By Mayo Clinic Staff