A heart attack, correctly termed a myocardial infarction, is a serious cause of chest pain in which one or more of the arteries that supply blood to the heart muscle are blocked. The most common cause is the rupture of a cholesterol plaque within a blood vessel which them triggers the formation of a blood clot which completely closes the vessel. This usually causes chest pain but can also cause pain in the upper abdomen or back. In some patients, particularly those with diabetes or in the elderly, there main not be any pain but just weakness or shortness of breath (a so-called ‘silent heart attack’).
We diagnose a heart attack using several tests including an EKG which measures electrical activity of the heart along with blood tests that can detect injury to heart muscle.
The aorta is the major artery that leaves the heart carrying oxygenated blood. Hypertension and other diseases can cause the aorta to split the layers causing severe pain. This is a potentially life-threatening condition. Treatment usually consists of blood pressure control and sometimes surgery.
Angina is the symptom of chest pain that occurs because of poor blood flow to the heart muscle through constricted coronary arteries though not yet a heart attack. It is a symptom of coronary artery disease. Angina is said to be unstable when it is new onset or worsening in frequency or severity. Unstable angina is important to recognize because a significant number of patients will go on to have heart attacks within a short period of time. A change in anginal symptoms should not be ignored.
Diagnosis requires a careful history and physical exam as well as tests such as the EKG and specialized blood tests. Most patients will require evaluation by a cardiologist to have specialized testing such as a cardiac catheterization to look directly at the coronary arteries.
This is a condition in which a blood clot from somewhere in the body, usually the legs or pelvis, breaks free and travels through the circulation into the lungs. A pulmonary embolism is like a heart attack of the lungs in which the ceessation of blood flow can damage the lungs and reduce the ability of the lungs to absorb oxygen. Classic symptoms include chest pain, particularly when taking a deep breath as well as shortness of breath. Pulmonary emboli are often missed because specialized testing is required and many patients do not have dramatic symptoms. However, the disease is still potentially life-threatening and should be investigated.
We can diagnose pulmonary emboli through a combination of testing including specialized blood tests, ultrasound, and CT scanning of the chest.
There are many other causes of chest pain including serious conditions. Our Emergency Medicine Residency-Trained Physicians are experts in the diagnosis and treatment of chest pain. We have advanced diagnostic equipment to aid in the diagnosis of the cause of your chest pain.