诊断

胸部疼痛并不总是心脏病发作的信号。但这是急诊室医生首先要检查的,因为这可能是对您生命最直接的威胁。他们还可能检查是否有危及生命的肺部症状,如肺塌陷或肺部血栓。

立即检查

医生可能会要求进行的一些初步检查包括:

  • 心电图(ECG)。此项检测通过连接到您皮肤上的电极记录您心脏的电活动。由于受伤的心肌不能正常传导电脉冲,因此心电图可显示您是否曾经历或正在经历心脏病发作。
  • 血液检测。医生可能会要求验血,以检查心肌中某些蛋白质或酶的含量是否增加。心脏病发作对心脏细胞的损害可能会使这些蛋白质或酶在数小时内渗漏到您的血液中。
  • 胸部 X 线检查。胸部 X 线可以让医生检查您的肺部状况以及心脏和主要血管的大小和形状。胸部 X 线检查也可以显示肺部问题,如感染性肺炎或肺塌陷。
  • 计算机断层成像(CT)。CT 扫描可以发现肺中血栓(肺栓塞),或者确定您没有主动脉夹层。

后续检测

根据这些初始检测的结果,您可能需要进行后续检测,包括:

  • 超声心动图。超声心动图利用声波产生心脏运动的视频图像。一个小装置可能会通过您的喉咙,以获得关于您心脏不同部位的更好视图。
  • 计算机断层成像(CT)。不同类型的 CT 扫描可以用来检查您的心脏动脉是否阻塞。CT 冠状动脉造影也可以用染料来检查心脏和肺动脉有无阻塞和其他问题。
  • 运动负荷试验。该试验测量您的心脏和血管对劳累的反应,这可能会表明您的胸部疼痛是否与心脏有关。运动负荷试验有很多种。您可能会被要求在跑步机上行走或踩一辆静止的自行车时连接心电图。或者您可能会被给予药物静脉注射,以刺激您的心脏使其处于类似于运动的状态。
  • 冠状动脉导管插入术(血管造影)。这个检测可以帮助医生识别出您心脏中可能狭窄或堵塞的动脉。利用一根细长管(导管)将液体染料注入心脏的动脉,这根导管通过手腕或腹股沟插入心脏动脉。随着染料逐渐填充动脉,动脉在 X 线和动态影像上变得可见。

Immediate tests

Some of the first tests a health care provider may order when evaluating chest pain include:

  • Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. An ECG can show if the heart is beating too fast, too slow or not at all. Because injured heart muscle doesn't conduct electrical signals in a typical pattern, the ECG may show that you have had or are having a heart attack.
  • Blood tests. Blood tests may be done to check for increased levels of certain proteins or enzymes typically found in heart muscle. Damage to heart cells from a heart attack may allow these proteins or enzymes to leak, over a period of hours, into the blood.
  • Chest X-ray. An X-ray of the chest can show the condition of the lungs and the size and shape of the 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 spot a blood clot in the lung (pulmonary embolism) or detect an aortic dissection.

Follow-up testing

Depending on the results from the initial tests for chest pain, you may need follow-up testing, which may include:

  • Echocardiogram. An echocardiogram uses sound waves to produce a video image of the heart in motion. A small device may be passed down the throat to obtain better views of different parts of the heart.
  • Computerized tomography (CT) scan. Different types of CT scans can be used to check the heart arteries for blockages. A CT coronary angiogram can also be done with dye to check the heart and lung arteries for blockages and other problems.
  • Stress tests. These measure how the heart and blood vessels respond to exertion, which may indicate if chest pain is heart related. There are many kinds of stress tests. You may be asked to walk on a treadmill or pedal a stationary bike while connected to an ECG. Or you may be given an IV drug to stimulate the heart in a way similar to exercise.
  • Coronary catheterization (angiogram) . This test helps health care providers see blockages in the heart arteries. A long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

治疗

治疗方法取决于引起胸部疼痛的原因。

药物治疗

可用于治疗导致胸部疼痛的一些最常见原因的药物包括:

  • 动脉松弛剂。硝酸甘油通常作为片剂置于舌下含服,它可以使心脏动脉保持放松,从而使血液更容易流经狭窄的空间。有些降压药还能放松血管,使血管变宽。
  • 阿司匹林。如果医生怀疑胸部疼痛与心脏有关,您可能需要服用阿司匹林。
  • 溶栓药物。如果您的心脏病正在发作,您可能需要服用这些溶栓药物。这些药物可以溶解阻碍血液到达心肌的血栓。
  • 血液稀释剂。如果您的心脏或肺部动脉有血栓,您将需要服用能够抑制血液凝固的药物,以防形成更多血栓。
  • 抑酸药。如果胸部疼痛是由于胃酸溅入食管所致,医生可能会建议您服用可减少胃酸的药物。
  • 抗抑郁药。如果您出现惊恐发作,医生可能会开具抗抑郁药来协助控制症状。医生可能还会推荐认知行为疗法等心理治疗。

外科手术及其他手术

可用于治疗某些最危险的胸部疼痛原因的手术包括:

  • 血管成形术和支架置入术。如果胸部疼痛是由于心脏动脉阻塞所致,医生会将末端带有球囊的导管插入腹股沟的大血管中,然后向上推动直至到达阻塞处。医生会给球囊头充气以促使动脉变宽,然后放气并取出导管。大多数情况下都会在导管的球囊头外侧放置小钢丝网管(支架)。当球囊膨胀时,支架便会锁定到位以保持动脉开放。
  • 搭桥手术。外科医生在手术期间会取出身体其他部位的某段血管,然后用其创建一条能让血液绕过被阻塞动脉的替代路径。
  • 夹层修复。您可能需要接受紧急外科手术才能修复主动脉夹层,这是一种危及生命的疾病,发生于负责将血液从心脏输送到身体其他部位的动脉破裂时。
  • 肺部再膨胀。如果您有肺萎陷,医生可能会将一根管子插入您的胸腔,以便让肺部再次膨胀。

Medications

Drugs used to treat some of the most common causes of chest pain include:

  • Artery relaxers. Nitroglycerin — usually taken as a tablet under the tongue — relaxes heart arteries, so blood can flow more easily through the narrowed spaces. Some blood pressure medicines also relax and widen blood vessels.
  • Aspirin. If health care providers think that your chest pain is related to your heart, you'll likely be given aspirin.
  • Thrombolytic drugs. If you are having a heart attack, you may receive these clot-busting drugs. These work to dissolve the clot that is blocking blood from reaching the heart muscle.
  • Blood thinners. If you have a clot in an artery feeding your heart or lungs, you'll likely be given drugs that interfere with blood clotting to prevent more clots from forming.
  • Acid-suppressing medications. If chest pain is caused by stomach acid splashing into the esophagus, a health care provider may suggest medications that reduce the amount of acid in the stomach.
  • Antidepressants. If you're having panic attacks, your health care provider may prescribe antidepressants to help control symptoms. Talk therapy, such as cognitive behavioral therapy, also might be recommended.

Surgical and other procedures

Procedures to treat some of the most dangerous causes of chest pain include:

  • Angioplasty and stent placement. Chest pain that is caused by a blockage in an artery feeding the heart is typically treated with angioplasty. The doctor inserts a catheter with a balloon on the end into a large blood vessel, usually in the groin, and guides the catheter to the blockage. The doctor inflates the balloon to widen the artery, then deflates it and removes the catheter. A small wire mesh tube (stent) is often placed on the outside of the balloon tip of the catheter. When expanded, the stent locks into place to keep the artery open.
  • Bypass surgery. During this procedure, surgeons take a blood vessel from another part of the body and use it to create an alternative route for blood to go around the blocked artery.
  • Emergency dissection repair. You may need emergency surgery to repair an aortic dissection — a life-threatening condition in which the artery that carries blood from the heart to the rest of the body ruptures.
  • Lung reinflation. If you have a collapsed lung, a health care provider may insert a tube in the chest to reinflate the lung.

临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法,旨在预防、检测、治疗或控制这种疾病。

准备您的预约

如果您遇到新的或原因不明的胸部疼痛,或持续时间较长的胸闷,请打电话叫救护车,或让人开车送您去急诊室。切勿因为担心这些状况并非真正的心脏病发作会导致尴尬局面而浪费时间。即使其他原因导致胸部疼痛,您也需要立即就医。

您可以做什么

在去医院的路上,与急救人员分享以下信息:

  • 症状。详细描述您的体征和症状,指出它们什么时候开始出现,以及任何能使疼痛好转或恶化的因素。
  • 病史。您以前有过胸部疼痛的情况吗?由什么原因导致?您或任何近亲有心脏病或糖尿病家族史吗?
  • 药物。列出您定期服用的所有药物和补充剂将对急救人员有帮助。您可能想提前准备一份这样的清单,放在钱包里随身携带。

这样在您到了医院后,就能很快进行医疗评估。根据心电图(ECG)和血液检测的结果,医生能够迅速确定您是否为心脏病发作,或者对您的症状给出另一种解释。此时医生可能会问您一些问题。如果您未获得以下信息,您可能应该询问:

  • 最有可能引起我胸部疼痛的原因是什么?
  • 是否还有其他原因可能引起我的症状或病症?
  • 我需要做哪些检查?
  • 我是否需要住院?
  • 我需要立即接受什么治疗?
  • 这些治疗是否有任何相关风险?
  • 诊断和治疗的后续步骤是什么?
  • 我还有其他医疗状况。这对我的治疗有什么影响?
  • 回家后我需要遵守哪些限制?
  • 我应该去看专科医生吗?

在医学评估期间如有其他问题,请随时提问。

医生可能会做什么

给您看胸部疼痛的医生可能会询问:

  • 您何时开始出现症状?它们随着时间的推移加重了吗?
  • 疼痛是否辐射到身体的任何其他部位?
  • 您会用哪些词语描述您的疼痛?
  • 除了胸部疼痛外,您是否还有其他体征和症状,例如呼吸困难、头晕、头重脚轻或呕吐?
  • 您是否有高血压?如果有,您使用哪些药物?
  • 您是否吸烟或曾经吸烟?用量有多少?
  • 您是否饮酒或喝咖啡?用量有多少?
  • 您是否使用违禁药物,例如可卡因?

What you can do

Share the following information with the emergency care providers, if possible:

  • Symptoms. Describe your signs and symptoms in detail, noting when they started and anything that makes the pain better or worse.
  • Medical history. Have you ever had chest pain before? What caused it? Do you or any close family members have a history of heart disease or diabetes?
  • Medications. Having a list of all the medications and supplements you regularly take will be helpful to the emergency workers. You might want to prepare such a list in advance to carry in your wallet or purse.

Once you're at the hospital, it's likely that your medical evaluation will move quickly. Based on results from an electrocardiogram (ECG) and blood tests, your health care provider may be able to quickly determine if you are having a heart attack — or give you another explanation for your symptoms. You'll probably have a number of questions at this point. If you haven't received the following information, you may want to ask:

  • What's the most likely cause of my chest pain?
  • Are there other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • Do I need to be hospitalized?
  • What treatments do I need right now?
  • Are there any risks associated with these treatments?
  • What are the next steps in my diagnosis and treatment?
  • I have other medical conditions. How might that affect my treatment?
  • Do I need to follow any restrictions after returning home?
  • Should I see a specialist?

Don't hesitate to ask additional questions that occur to you during your medical evaluation.

What to expect from the doctor

A health care provider who sees you for chest pain may ask:

  • When did your symptoms start? Have they gotten worse over time?
  • Does your pain spread to any other parts of your body?
  • What words would you use to describe your pain?
  • Do you have signs and symptoms other than chest pain, such as trouble breathing, dizziness, lightheadedness or vomiting?
  • Do you have high blood pressure? If so, do you take medicine for it?
  • Do you or did you smoke? How much?
  • Do you use alcohol or caffeine? How much?
  • Do you use illegal drugs, such as cocaine?

在 Mayo Clinic 治疗

July 09, 2022
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