How is it Diagnosed?
The diagnosis of chest pain involves a systematic approach to determine its underlying
cause, which can range from benign to life-threatening. The first step is a detailed
clinical history and physical examination, assessing pain location, character (sharp, dull,
pressure), duration, triggering factors, and associated symptoms like sweating,
shortness of breath, or nausea.
Based on initial evaluation, electrocardiogram (ECG) is a key diagnostic test, used to
detect ischemic changes suggestive of myocardial infarction or angina. If the ECG is
inconclusive and suspicion of cardiac cause remains, cardiac biomarkers such as
troponins are tested to confirm myocardial injury.
Chest X-ray helps assess pulmonary causes such as pneumonia, pneumothorax, or rib
fractures. In suspected pulmonary embolism, a D-dimer test may be followed by CT
pulmonary angiography.
For gastrointestinal causes like acid reflux or esophageal spasm, diagnosis may include
upper GI endoscopy or esophageal pH monitoring. In cases suggestive of
musculoskeletal pain, a physical exam and possibly a bone scan or MRI are used.
When aortic dissection is suspected, CT angiography of the chest is the imaging
modality of choice. In stable patients, stress tests, echocardiography, or coronary
angiography might be employed to assess coronary artery disease.
The diagnosis is ultimately based on integration of history, physical findings, and test
results. Prompt and accurate diagnosis is crucial to rule out emergent conditions like
myocardial infarction, aortic dissection, or pulmonary embolism.