Exams and Tests

Chest pain can occur for a number of reasons, some that are serious and some that are harmless. Separating angina from other causes of chest pain is not always easy.

Your health care professional will take a thorough history and physical exam. They will ask you about the pain in your chest. Where do you feel it? Do you have other symptoms as well? When do you feel it? How long does it last? What makes it better or worse? 

An electrocardiogram (ECG), which shows how fast or evenly the heart is beating, may be done to look for signs of past heart attacks or decreased blood flow to the heart muscle, called ischemia. It also can help show what type of stress test you may need. 

If your health care professional is concerned that your chest pain may be caused by coronary artery disease, they may order a stress test with or without pictures. During a stress test, a clinician tries to challenge your heart to see if the supply of blood to your heart muscle is enough to meet the demands of increased activity.

A stress test can tell us if there are further signs of decreased blood flow to the heart muscle. The pictures can tell us if parts of your heart muscle do not get enough blood flow. Other types of imaging stress tests use ultrasound to take pictures of the heart muscle before and after exercise. In these tests reduced heart muscle movement suggests that the blood flow to that heart muscle has a tightness or blockage.

Other tests, such as coronary calcium score and coronary computed tomography, can look for atherosclerosis (plaque buildup) or narrowing of the coronary arteries. Sometimes a stress cardiac MRI can be used to assess blood flow to the heart muscle.

If there is a concern about a heart attack, blood work may be done. You may be advised to go directly to the emergency department.