Tests and diagnosis

By Mayo Clinic Staff

Chest pain doesn't always signal a heart attack. But that's what emergency room doctors will test for first because it's potentially the most immediate threat to your life. They may also check for life-threatening lung conditions — such as a collapsed lung or a clot in your lung.

Immediate tests

Some of the first tests you may undergo include:

  • Electrocardiogram (ECG). This test records the electrical activity of your heart through electrodes attached to your skin. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
  • Blood tests. Your doctor may order blood tests to check for increased levels of certain enzymes normally found in heart muscle. Damage to heart cells from a heart attack may allow these enzymes to leak, over a period of hours, into your blood.
  • Chest X-ray. An X-ray of your chest allows doctors to check the condition of your lungs and the size and shape of your heart and major blood vessels. A chest X-ray can also reveal lung problems such as pneumonia or a collapsed lung.
  • Computerized tomography (CT scan). CT scans can be used to look for a blood clot in your lung (pulmonary embolism) or to check your aorta to make sure you're not having aortic dissection.

Follow-up testing

Depending upon the results from these initial tests, you may need follow-up testing, which may include:

  • Echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart in motion. In some cases, a small device may be passed down your throat to obtain better views of different parts of your heart.
  • Computerized tomography (CT scan). Different types of CT scans can be used to check your heart arteries for signs of calcium, which indicate areas where plaque blockages are accumulating. CT scans can also be done with dye to check your heart and lung arteries for blockages and other problems.
  • Stress tests. These measure how your heart and blood vessels respond to exertion, which may indicate if your pain is related to your heart. There are many kinds of stress tests. You may be asked to walk on a treadmill or pedal a stationary bike while hooked up to an ECG. Or you may be given a drug intravenously to stimulate your heart in a way similar to exercise.
  • Coronary catheterization (angiogram). This test helps doctors identify individual arteries to your heart that may be narrowed or blocked. A liquid dye is injected into the arteries of your heart through a catheter — a long, thin tube that's fed through an artery, either through your wrist or your groin, to arteries in your heart. As the dye fills your arteries, they become visible on X-ray and video.
Nov. 26, 2014

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