What tests are done for chest pain?-2021

In this informative article, you will read about what tests are done for chest pain? Each case of chest pain with one or more warning signs or symptoms is treated as a medical emergency. 

In most settings, an X-ray and an ECG (electrocardiogram) are the two investigative techniques that can be conducted with immediate test results available.

Other tests may require treatment periods that are not feasible in the event of a medical emergency.

Nevertheless, if facilities are available, the emergency physician may consider one or more of these chest pain tests while continuing the appropriate treatment.

What tests are done for chest pain?

Chest pain tests are useful for confirming a diagnosis, but a qualified doctor can often make a diagnosis based on a patient’s clinical findings, medical history, and specific case taking.

Due to the severe nature of chest pain, many tests are performed regularly even if serious medical conditions are not suspected by the attending physician.

[1] Chest X-ray:

  • Depending on the presentation and clinical results, a doctor may look for specific features on a chest X-ray. A posteroanterior (BP) and lateral X-ray will be performed. Some of the common features that can be noted include:
  • Tracheal alignment ( tracheal deviation ), pulmonary segments, and any signs of effusion ( fluid in the lungs ).
  • Enlargement of the mediastinum, size, and shape of the heart and shape, size, and position of the main blood vessels.
  • Fracture of the sternum, collarbone, shoulder blade, or ribs.
  • Change in the curvature of the spine (lordosis and kyphosis).
  • Height of the vertebral body and disc spaces.
  • Any foreign object or abnormal opaque mass.

Chest X-ray image. Postero-anterior view.

A chest x-ray may be useful to prompt further investigation or to diagnose the following conditions:

Chest pain

  • Abscess, empyema
  • Foreign body in the respiratory tract
  • Lung cancer or tumor
  • Pneumonia
  • Pneumothorax
  • Tuberculosis

Heart chest pain

  • Thoracic aortic aneurysm and dissection
  • Cardiomegaly
  • Pericardial effusion

Stomach chest pain

  • Cancer or tumor of the esophagus
  • Esophageal rupture
  • Foreign body in the esophagus
  • Gastric tumor
  • Hiatal hernia

Bone chest pain

  • Disc degeneration
  • Fractures
  • Joint luxation
  • Osteoporosis

A breast tumor can also be identified on a chest x-ray.

These are not the only conditions that can be identified with a chest x-ray.

[2] ECG, EKG (Electrocardiogram):

An ECG monitors the electrical activity of the heart.

This investigative technique can be useful to prompt further investigation or to diagnose the following:

  • Myocardial ischemia/infarction – angina, heart attack
  • Myocarditis
  • Pericarditis

These are not the only conditions that can be identified with an ECG. 

[3] Angiography:

  • CT Angiography:

A CT (computed tomography) angiographic scan uses a series of X-rays from different angles to render a 3D view of the area.

A radiopaque contrast (dye) is injected into the bloodstream and highlights the arteries during scanning.

This is the most effective method for assessing blood supply to the heart. It is cheap, fast, and less invasive than the angiography mentioned below.

Computed tomography angiography provides detailed images and with an ARM (magnetic resonance angiography), it is the preferred method for mapping the blood supply to the coronary artery.

Coronary angiography may be performed if narrowing or blockage of the coronary arteries is suspected and CT angiography is not available.

  • Coronary Angiography:

Also known as angiographya coronary angiography involves injecting a special dye directly into your coronary artery.

A long, flexible tube, called a catheter, is inserted into one of the blood vessels in your arm, upper thigh, or neck.

This catheter is directed to the coronary arteries where a dye is released into the bloodstream and through special X-ray imaging, the flow of the dye can be monitored.

This will highlight any constriction or blockage in case of coronary heart disease. Angiography will also detect enlargement and malformation of blood vessels, even those other than coronary arteries.

  • CT Angiography:

A CT (computed tomography) angiographic scan uses a series of X-rays from different angles to render a 3D view of the area.

A radiopaque contrast (dye) is injected into the bloodstream and highlights the arteries during scanning.

This is the most effective method for assessing blood supply to the heart. It is cheap, fast, and less invasive than the angiography mentioned below.

Computed tomography angiography provides detailed images and with an ARM (magnetic resonance angiography), it is the preferred method for mapping the blood supply to the coronary artery.

Coronary angiography may be performed if narrowing or blockage of the coronary arteries is suspected and CT angiography is not available.

  • Coronary Angiography:

Also known as angiography, a coronary angiography involves injecting a special dye directly into your coronary artery.

A long, flexible tube, called a catheter, is inserted into one of the blood vessels in your arm, upper thigh, or neck.

This catheter is directed to the coronary arteries where a dye is released into the bloodstream and through special X-ray imaging, the flow of the dye can be monitored.

This will highlight any constriction or blockage in case of coronary heart disease. Angiography will also detect enlargement and malformation of blood vessels, even those other than coronary arteries.

[4] Stress Tests:

In an emergency situation, a stress test will usually not be performed.

It is helpful to report any stress-induced chest pain (see Chest pain due to stress) as this may prompt your doctor to perform one or more of the following stress tests as soon as possible.

  • Stress ECG, electrocardiogram test

This involves an ECG test with simultaneous blood pressure monitoring while the patient walks (treadmill) or pedals (stationary bike).

  • Stress echocardiogram

This involves ultrasound imaging of the heart and ECG and blood pressure monitoring is performed simultaneously while the patient walks or pedals.

  • Thallium stress test

This test involves nuclear imaging of blood flow through the heart muscle at rest and during activity. This procedure is not performed as often as an exercise

ECG or stress echocardiogram due to the cost, the need for specialized facilities, and the risk of complications.

[5] Blood Tests:

(a) Complete blood count, ESR, and C-reactive protein

  • Acute and chronic infections
  • Inflammatory conditions

It is important to note that chest pain can be a symptom of infection or inflammation elsewhere in the body.

Abnormal results can indicate a multitude of possible conditions and are only useful to the doctor when clinical findings and the results of other tests are taken into account.

  • Myocarditis or pericarditis can be diagnosed based on reported symptoms, clinical outcomes, and the results of other tests such as chest x-rays, ECGs, and serum heart markers.
  • Tuberculosis can be diagnosed on the basis of reported symptoms, clinical results and the results of a chest x-ray and sputum culture.

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Please note that attempting to interpret the results of diagnostic tests and therefore self-diagnose is irresponsible and dangerous. Instead, leave the diagnosis to the attending physician.

(b) Cardiac Markers.

This will help the doctor identify inflammation, ischemia, and infarction of the heart muscle.
Serum cardiac markers will be useful for diagnosing:

  • Myocardial infarction (myocardial infarction or heart attack)
  • Pericarditis
  • Myocarditis

(c) Other Blood Tests.

Serum amylase and lipase may be requested if pancreatitis is suspected.

An H.pylori antibody test may be requested if a peptic ulcer or gastritis is suspected.

(d) Other Investigations.

Other Lab tests for chest pain are also required. Based on the symptoms present, clinical results, case history, and/or results of other tests, the doctor may order additional tests to diagnose the cause of chest pain. Such investigative techniques may include:

  • MRI (magnetic resonance imaging)
  • Ultrasound
  • Endoscopy
  • Barium swallow

Conclusion:

The specific disorders identified are treated.

If the cause is not clearly benign, the patient is usually hospitalized or admitted to an observation department for cardiac monitoring and more extensive evaluation.

Symptoms are treated with acetaminophen or opioids as needed until a diagnosis is made. Now you know very well what tests are done for chest pain.

Key points about chest pain

  • Chest pain can be caused by potentially life-threatening disorders, so people with recent-onset chest pain (within a few days) should see a doctor immediately.
  • As symptoms of life-threatening or non-life-threatening disorders, tests are usually needed to determine the cause.

THANKS

I hope you will get some knowledge about Chest pain and its tests by reading this article. Comment down your thoughts on this article below. If you have any queries, then ask My Voice

MANU SAIYED

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