Chest Pain (Initial Evaluation & Triage) | Avecina Medical


Many ER visits happen due to chest pain. Most people with pain in the chest do not have a heart attack. It is usually caused by anxiety, heartburn, musculoskeletal pain or other reasons.  However, chest pain may be due to cardiac conditions or blood clots in the pulmonary arteries and should be investigated.

Heart attacks and blood clots in the lungs can lead to death. Sometimes symptoms of heart attack are very mild and can be easily missed. It can present as mild abdominal pain or nausea. It usually happens in women, people with diabetes and older than 60. 

Symptoms that are most likely due to a serious problem are:

  • Pain or pressure in the middle of the chest that travels to the left arm, hand or jaw.
  • Difficulty breathing.
  • Sweating and having cold clammy skin.
  • Dizziness or fainting.
  • Skipping of heart beats, feeling of heart racing.
  • Nausea and vomiting associated with dizziness and chest pain.
  • Chest pain or shortness of breath caused by exertion.
  • Symptoms that last for a prolonged time and not just seconds.

Physicians use different tools to diagnose and treat heart attack:

Blood tests to determine if heart muscle was damaged by a lack of blood supply (cardiac enzymes), or by clots in the lung blood vessels from “pulmonary embolism or PE” (clot markers).

ECG or electrocardiogram is a test that records electrical activity on the surface of the heart and may reveal presence of heart attack or abnormal rhythm (some abnormal rhythms are lethal). ECG can still be normal in the presence of heart attack.  

Stress Test that makes heart work harder and blood in the vessels feeding heart muscles goes to open vessels and steals blood from blocked once causing weakness of a heart muscle seen on heart ultrasound called stress echo. Lack of blood supply can be also detected on nuclear or ECG stress test.  Stress test can be exercise (treadmill or bicycle) or pharmacological when medication is injected simulating conditions during exercise. 

“Cardiac cath” (catheterization) is an ultimate test that visualizes cardiac blood vessels and cardiac chamber and reveals clogged coronary (cardiac) arteries. It is done by inserting catheter through a blood vessel in an arm or groin all the way to the heart and injecting dye while taking pictures and recording video using X-ray.

Cat Scan (special X-ray) may detect ether extra calcium in the blood vessels or blocked vessels if contrast (dye) is used.

Of course, chest pain may also be due to an infection in the lungs (pneumonia), outer heart lining (pericarditis), shingles, rib or muscle sprain.

Most important: call 911 if someone or self is in distress.


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