Chest pain diagnostic studies
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Chest pain Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
There are several tests that may be obtained in the setting of chest pain. The most common and important study is the electrocardiogram to help in evaluating for a myocardial infarction. Additional studies are ordered based on the findings in the patient history, physical examination, and laboratory studies.
Diagnostic Studies
Electrocardiogram
- Electrocardiogram is usually required for initial evaluation.
- ST elevation should require further urgent evaluation for reperfusion therapy.
- Salient findings on ECG are:
- New ST elevation (>1 mm) or Q waves on ECG (MI)
- ST depression >1 mm or ischemic T waves (unstable angina)
Chest X Ray
- A chest X-ray can be useful in the initial evaluation of the patient to ascertain if there is cardiomegaly, pulmonary edema and aortic dissection.
- CT scanning may be better but is often not available.
Echocardiography or Ultrasound
- Echocardiogram usually required for patients with suspected coronary artery disease
- To rule out aortic dissection, transesophageal echocardiogram of the chest may be indicated
MRI and CT
- CT angiography, lung scan may be helpful in ruling out pulmonary embolism These tests are sometimes combined with lower extremity venous ultrasound or D-dimer testing.
- To rule out aortic dissection, a CT scan chest with contrast, MRI or transesophageal echocardiography can be used.
Other Diagnostic Studies
- V/Q scintigraphy or CT Pulmonary angiogram (when a pulmonary embolism is suspected)
- For patients who are suspected to have coronary artery disease may require stress testing or cardiac catheterization
- Peak flow studies and pulmonary function tests may be indicated for patients requiring further evaluation
OtherImaging Findings
- Upper gastrointestinal endoscopy if esophagitis is suspected