Chest pain diagnostic studies

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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