Chest pain diagnostic studies

There are several tests that may be obtained in the setting of chest pain. The most common and important study is the electrocardiogram to help in evaluating for a myocardial infarction. Additional studies are ordered based on the findings in the patient history, physical examination, and laboratory studies.

• Electrocardiogram is usually required for initial evaluation.
• ST elevation should require further urgent evaluation for reperfusion therapy.
• Salient findings on ECG are:
  • New ST elevation (>1 mm) or Q waves on ECG (MI)
  • ST depression >1 mm or ischemic T waves (unstable angina)

• A chest X-ray can be useful in the initial evaluation of the patient to ascertain if there is cardiomegaly, pulmonary edema and aortic dissection.
• CT scanning may be better but is often not available.

• Echocardiogram usually required for patients with suspected coronary artery disease
• To rule out aortic dissection, transesophageal echocardiogram of the chest may be indicated

• CT angiography, lung scan may be helpful in ruling out pulmonary embolism These tests are sometimes combined with lower extremity venous ultrasound or D-dimer testing.
• To rule out aortic dissection, a CT scan chest with contrast, MRI or transesophageal echocardiography can be used.

• V/Q scintigraphy or CT Pulmonary angiogram (when a pulmonary embolism is suspected)
• For patients who are suspected to have coronary artery disease may require stress testing or cardiac catheterization
• Peak flow studies and pulmonary function tests may be indicated for patients requiring further evaluation

• Upper gastrointestinal endoscopy if esophagitis is suspected