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Chest Pain (cont.)

Exams and Tests

Heart Attack

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

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.

Aortic Dissection

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 general anesthesia.
The dissection may be identified very accurately by a CT scan of the chest or angiography.

Pulmonary Embolism

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 definitive.
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

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.

Pericarditis

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

Pneumonia is diagnosed by the patient's symptoms and medical history, physical examination, and chest x-ray.

Esophagus

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.