Americans make more than 7 million trips to emergency departments each year for chest pain, according to statistics compiled by the Centers for Disease Control and Prevention. But only about 30 percent of those people end up being diagnosed with a heart attack or—more often—unstable angina (where narrowed arteries restrict blood flow to the heart).
Still, chest pain is not something you should dismiss or try to diagnose yourself, particularly if you have risk factors for a heart attack.
If you experience chest pain, be sure to call 911 rather than have someone drive you to the hospital. (And never try to drive yourself.) The paramedics will begin your care as soon as they arrive; they can give you oxygen and medications, and in some cases may be able to perform an electrocardiogram (ECG) in the ambulance, which will speed your diagnosis. They will also notify the ED that they’re bringing in a patient with chest pain. All of this buys you critical minutes in getting the right diagnosis and treatment.
What happens at the hospital
When you arrive at the hospital, you’ll be given chewable aspirin (if paramedics haven’t given it to you already), oxygen through a nasal tube, and possibly other medications—such as nitroglycerin to improve blood flow to the heart. You’ll also be placed on monitors to check your heart rate, blood pressure, and other vital signs.
The ED team will have a lot of questions as well: What does the pain feel like? Where exactly is it located? When did it start? Does it come and go? What other symptoms are you having? In addition, the doctor will perform a physical exam, using a stethoscope to listen to your heart and lungs, for example. As high-tech as medicine can be today, nothing replaces those basic steps.
The key initial tests are an ECG, which detects abnormal electrical activity in the heart, and blood tests measuring a protein called troponin; high levels indicate damage to the heart muscle.
Both tests should be done soon after you arrive in the ED; typically, a second troponin test is done within a few hours. The ECG may also be repeated, especially if you have ongoing chest pain. If those early tests indicate a high likelihood of a heart attack, you’ll be admitted to the hospital for further tests and treatment.
If your vital signs, ECG results, and troponin tests are all normal, the odds that you had a heart attack are low. But because they aren’t zero, you’ll likely be moved from the ED to an observation unit.
There you’ll be monitored with further ECGs and troponin measurements, and possibly other tests—such as a treadmill test, to see if exercise triggers another chest pain episode. (Some research has questioned the necessity of prolonged observation, which varies by hospital but can last up to 24 hours.)
It’s a good idea to be prepared should you ever land in the emergency department. One way is to keep a file handy—on paper or stored in your cell phone—that lists your chronic health conditions; medications and supplements that you’re taking, along with the dosages; any allergies; and contact information for your primary care physician, family members, and healthcare insurance provider.
In the midst of a possible emergency, it’s better not to rely on memory alone.