Chronic Chest Pain

Diagnosis

Patients who seek evaluation and care for chronic chest pain at Mayo Clinic can expect to undergo several tests, even though some or all of them may have been done previously elsewhere. Nonetheless, it is often helpful to have patient records and test results sent to Mayo Clinic in advance of arrival.

Mayo physicians see patients who fit within one of three profiles:

1. Those with non-obstructive coronary artery disease, or normal coronary arteries, who experience atypical chest pain. These individuals are particularly important to identify and begin preventive treatment for coronary artery disease.
2. Those who have had a previous heart attack, angioplasty, stent or coronary artery bypass graft (CABG) and continue to have chest pain despite medical management.
3. Individuals with a complex cardiac history or known coronary artery disease not amenable to treatment with conventional angioplasty or cardiac surgery.

An evaluation begins with a patient history and physical exam by a Mayo physician and some common blood tests. Other commonly ordered tests include:

• Chest X-ray
• ECG
• Coronary diagnostic angiogram
• Endothelial dysfunction testing
• Specialized stress testing using nuclear and PET scans

Depending on test results, patients may be referred to other specialized areas within Mayo for additional testing and therapy. Common referral areas include:

• Endocrinology
• Gastroenterology
• Hypertension
• Lipid management
• Nicotine dependence
• Patient and health education
• Pulmonary medicine
• Sleep disorders
• Vascular medicine
• Weight/nutrition counseling

Visits to other areas are coordinated by the patient's primary physician. Results from these visits come back to the primary physician to help develop a treatment plan. Mayo Clinic's goal is to render an accurate diagnosis then pursue the most promising course of treatment, whatever the source of the patient's chronic chest pain. Mayo Clinic's multidisciplinary practice brings together the collective wisdom of many specialists for the benefit of the patient.