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Pain in Chest, Chest Discomfort
Chest Pain

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Do I Need to See a Doctor?

This may depend on whether or not your doctor has ever told you that you have coronary artery disease.

People Without Known Coronary Artery Disease

Many people do not know if they have heart disease. Any new or severe chest discomfort that is not related to an injury, such as a pulled muscle, could be unstable angina or a heart attack.

Unstable angina is not dangerous to most people who get medical care right away, but it can be very serious if it is not treated. Even anginal pain that goes away with rest can be serious. Only your doctor will be able to tell how serious it is and what should be done.

People with Known Coronary Artery Disease

If you have coronary artery disease, your past symptoms are the best guide to whether you should call your doctor about new symptoms. Call your doctor if the discomfort you are having is more severe or lasts longer than the discomfort you have had before, has begun to happen more frequently or with less effort, or happens when you are resting or asleep.

Chest Pain Can Be An Emergency

Here are some signs that your angina is very serious and you should go to the hospital right away:

  • Pain or discomfort that is very bad, gets worse, and lasts longer than 20 minutes.
  • Pain or discomfort along with weakness, feeling sick to your stomach, or fainting.
  • Pain or discomfort that does not go away when you take three nitroglycerin tablets .
  • Pain or discomfort that is worse than you have ever had before.

If you live in an area where ambulance service is not quickly available, have someone drive you to the nearest hospital. You should not drive yourself to the hospital.

It is a good idea to talk with your family, friends, or neighbors about your heart condition and have them read this booklet. They should be familiar with warning signs that signal when you should go to the hospital. You also may want to tell them which medicines you are taking and where you keep them.

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What Will Happen in the Emergency Room?

At your hospital emergency room, the doctors and nurses will decide if you have unstable angina. If you do have unstable angina, they will give you medicines through a vein in your arm to stop your pain and prevent injury to your heart. These medicines will help prevent blood clots and help your heart work more easily. You probably will be given oxygen to help you breathe and get more oxygen in your blood.

The doctors and nurses will ask how you are feeling and if the medicines have stopped your discomfort. It is important to tell them how you really feel. If the medicines do not stop your discomfort, there are other things they can do to help you.

These things need to be done quickly. The doctors and nurses may not be able to explain everything as it is happening. There will be time for you to ask questions after your doctor finds out how serious your condition is.

What is an Electrocardiogram?

When you are in the emergency room you may have an electrocardiogram, called an ECG or EKG. An ECG records on paper the electrical activity of your heart beat. The ECG may show your doctor if your heart muscle is getting enough oxygen-rich blood.

Will I Have to Stay in the Hospital?

Your ECG, past medical history, and the nature of your pain tell your doctor how serious your problem is.

If your doctor does not consider your condition to be serious enough to admit you to the hospital, he or she may make an appointment to see you in a day or two for more tests. If your chest discomfort comes back before this appointment, "Chest Pain Can Be an Emergency," you should return immediately to the hospital.

It is not easy to accurately diagnose unstable angina, and your doctor may need to see you more than once to be sure.

If your doctor suggests admission to a hospital, you may be put in a regular bed or in an intensive care unit. In either case, treatment will continue while your doctor does more tests.

The tests you have will depend on how serious your condition is and how well the medicines control your discomfort.

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What Tests Will I Have?

There is more than one kind of test your doctor can do to decide how badly your coronary arteries are blocked. Some of these tests are usually done while you are in the hospital. Other tests can be done in the hospital, but you do not have to stay overnight. Some tests can be done in your doctor's office.

Stress Tests

You may have an exercise tolerance test. In this test you will be asked to ride a stationary bicycle or walk on a treadmill while a doctor takes an ECG. Your doctor may give you an injection of a radioactive drug that shows up on special cameras. This allows your doctor to make pictures of how your heart moves and the way your blood flows.

This test will let the doctor see the changes that take place in your heart when you exercise. Trained personnel or the doctor will watch your condition by asking how you are feeling during the test. Be sure to follow their instructions carefully and tell them exactly how you feel.

If you have other health problems, you may be given another kind of stress test that does not use exercise. If you have this test, you will be given a special type of drug that makes your heart beat faster and opens your coronary arteries. An ECG will be taken at the same time. This test gives the doctor the same type of information as the exercise tolerance test.

The exercise tolerance test or other stress test will help your doctor tell how well your heart is functioning. Although stress tests are useful, they cannot tell your doctor exactly where your arteries are blocked or how bad the blockages may be. Also, these tests are accurate no more than 90 percent of the time. In some cases, doctors will want to do a cardiac catheterization.

Cardiac Catheterization

An angiogram or cardiac catheterization (sometimes called a cath) lets the doctor see the coronary arteries. A thin tube, called a catheter, is placed in an artery in either your arm or leg. The catheter is threaded up to your heart while your doctor watches on a screen.

The catheter will measure the blood pressure in your heart to see how well it is pumping blood. Then, a liquid is injected through the catheter into the artery, and x-rays are taken. The x-rays allow the doctor to see how much blockage there is and where it is located.

Cardiac catheterization is a test and not a treatment for unstable angina. A treatment called angioplasty looks and feels a lot like cardiac catheterization.

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Chest Pain