When Chest Pains Are Serious

Unlike an achy knee or crabby lower back, chest pain isn’t something to shrug off until tomorrow. It also isn’t something to diagnose at home. Don’t play doctor go see one, fast, if you are worried about pain or discomfort in your chest, upper back, left arm, or jaw or suddenly faint or develop a cold sweat, nausea, or vomiting. Call 911 or your local emergency number to summon an emergency medical crew. It will whisk you to the hospital in a vehicle full of equipment that can start the diagnosis and keep you stable if your heart really is in trouble.

There are oh-so-many reasons to delay calling for help.

• I’m too young .
• I’m in great shape .
• I have a family to take care of .
• I don’t want to bother anyone .

Reducing Unnecessary Tests And Interventions

The new guidelines recommend that all patients with chest pain get a specific blood test to diagnose or rule out a heart attack.

Developed in part at UT Southwestern, the high-sensitive serial assessment of cardiac troponin blood test can detect troponin T in the blood. This protein shows whether the patient is having a heart attack, had one recently, or has incurred heart muscle damage.

Providers can then order appropriate tests by combining information from the patients cTn results, category of chest pain, and personal heart disease risk factors, such as:

• Age, since cardiovascular risk increases over time
• History of coronary artery disease, a major risk factor for heart disease
• Overall health
• Persistent chest pain despite previous medical treatment
• Symptom severity

The blood test results are typically available in about an hour, so this personalized approach can reduce wait times in the ER, overall saving hours of wait time. Patients quickly receive customized care, saving time and money.

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Q What Can You Do If You Are Diagnosed With Angina

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What Does A Stress Test Show

For men with symptoms like chest pain with activity or unexplained shortness of breath, an abnormal stress test points to a higher risk of CAD. But it’s more worrisome in a man who also has risk factors like older age, being overweight, or high cholesterol. “This points strongly to coronary artery disease.” Dr. Bhatt says. Confirming it could require further testing.

If you have symptoms and the test result looks normal, the risk of CAD is lower. “That person is less likely to have significant coronary artery disease,” Dr. Bhatt says. Even so, the doctor might still want to do more tests.

But it’s important to understand that a “normal” stress test can’t rule out the chance that a plaque will later rupture and block an arterythe proverbial tale of the man who passes a stress test with flying colors and then has a heart attack a week later. Stress testing detects arteries that are severely narrowed . This is what causes symptoms. Heart attacks often result from lesser blockages that rupture and form clots.

Heart Tests Your Doctor Might Order And What They Mean

Heart disease patients and those suspected of having heart disease often face a battery of tests. Find out what you should expect if one of these noninvasive heart tests is in your future.

This post is part of a mini blog series dedicated to bringing awareness about your heart health during the American Heart Association’s national #HeartMonth. Miss the other stories? Catch up on 5 Eating Tips for a Healthy Heart, How To Check Your Blood Pressure at Home, How to Know If You’re Having a Heart Attack and Getting Heart Healthy with a Mediterranean Diet.

MRIs. CT scans. ECGs. There are a lot of test names you may hear when you visit your cardiologist, but what are all these tests and why do you need them?

If you have heart issues or are suspected of having a heart condition, your doctor may order an array of tests. But whats their purpose and what should you expect? Michigan Medicine cardiologist Venkatesh Murthy, M.D., offers a guide to the various noninvasive tests your doctor may order, including what theyre designed to do.

1. Echocardiogram: Uses sound waves to produce images of your heart. This common test allows your physician to see how your heart is beating and how blood is moving through your heart. Images from an echocardiogram are used to identify various abnormalities in the heart muscle and valves. This test can be done while youre at rest or with exercise to elevate your heart rate .

Reasons for the test:

Reasons for the test:

Reasons for the test:

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Q What Is The Outlook For People With Chest Pain

Primary Esophageal Motility Disorders

Chest pain associated with PEMDs: mild, and may feel like heartburn

PEMDs include several different disorders of the esophagus.

With a PEMD, you could experience:

• mild chest pain or heartburn
• trouble swallowing
• the sensation that food is sticking in your esophagus

See a doctor soon if you have these symptoms.

Treatment options include medications to help relax the muscles to ease swallowing, as well as minimally invasive surgical procedures.

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What Did This Study Do

This review identified 11 cohorts including 9,241 adults presenting to the emergency department with chest pain. All received an ECG and high sensitivity troponin T test.

Researchers looked at whether a troponin level of less than 0.005 µg/L when combined with normal ECG, was accurate in ruling out a heart attack. Heart attack was confirmed, independently in most studies, according to the Universal Global Task Force definition. Other outcomes were death or major adverse cardiac event within 30 days.

Nine of the 11 studies had a high or unclear risk of bias. Individual studies varied in patient characteristics, timing and number of troponin tests, and their results. These factors may make meta-analysis inappropriate. All studies were from developed countries, but only one was from the UK.

What Did It Find

• 30.6% of patients with chest pain were defined as low risk and tested negative, with a normal ECG and high sensitivity troponin below threshold .
• These patients, testing negative, were almost certain not to have had a heart attack. The pooled negative predictive value was 99.3% .
• Only 14 patients had a false negative result and were later confirmed to have had a heart attack. Seven of these were tested within three hours of the start of the pain. The pooled sensitivity was 98.7% and was good across studies, ranging from 87.5% to 100%.
• The test wasnt good for diagnosing a heart attack and gave a high number of incorrect positive results in people without a heart attack. Pooled specificity was 64% . Specificity was low across studies but highly variable, ranging from 5% to 79%. Overall less than a quarter of people testing positive had a heart attack .
• The test accurately identified almost all patients who died or had a major cardiac adverse event within 30 days . A total of 126 patients died , none of whom was in the low risk/test negative category.

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What Do Normal Stress Test Results Mean

If the results are normal, your heart is pumping as it should and there is adequate blood flow. What this means for your health depends on why you underwent stress testing:

• Heart disease evaluation: Symptoms are not due to a heart issue. You may need other evaluations to pinpoint the cause. For example, some people with anxiety experience chest pain and a racing heart even though their heart is healthy.
• Exercise or surgical planning: Your heart is healthy enough to start an exercise program or for you to undergo surgery.
• Heart disease monitoring: The treatments you are receiving are right for your needs. Your heart is capable of keeping up with your bodys demands.

How Much Do Heart Checkups Cost

You may be able to access heart health screening tests at low or no cost, depending on where you live and your insurance coverage.

If you dont have health insurance, federal health centers offer many essential health services regardless of ability to pay. You can see if theres a qualified health center near you using their search tool.

Some pharmacies also offer free heart health screenings in February, National Heart Health Month.

If you have health insurance, you may have no cost for basic heart checkup tests. Under the Affordable Care Act, many health insurance plans are required to cover the cost of certain preventive health screenings with no copayment, coinsurance, or deductible fee.

Depending on your health insurance coverage, age, and health history, you may be able to get blood pressure, blood cholesterol, and blood sugar screenings for free.

If your doctor orders additional tests to evaluate your heart health, you may have charges for those tests. Some or all of the cost of the tests may be covered by your health insurance.

If you have health insurance, contact your insurance provider to learn if youre eligible for free heart health screenings. Ask them how much specific tests will cost.

Depending on your health history, your doctor might encourage you to monitor your own heart health and risk factors between checkups.

For example, they might advise you to monitor one or more of the following:

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How Is Chest Pain Diagnosed

Seek emergency treatment immediately if you think you may be having a heart attack and especially if your chest pain is new, unexplained, or lasts more than a few moments.

Your doctor will ask you some questions, and your answers can help them diagnose the cause of your chest pain. Be prepared to discuss any related symptoms and to share information about any medications, treatments, or other medical conditions you may have.

How Much Does An Er Ct Angiogram Cost

About $1,500. But admit a patient to the hospital for telemetry monitoring and stress tests?

Youre looking at over $4,000.

This often happens to patients who turn out not to have any serious coronary blockage, and could have been avoided with the quicker, much cheaper CT angiogram.

The evidence now clearly shows that when used in appropriate patients in the ED, we can safely and rapidly reduce hospital admission and save money, explains Dr. Hollander.

Perhaps a national coverage decision is just around the corner that will facilitate coronary CTA in the emergency department, adds Dr. Hollander.

Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. Shes also a former ACE-certified personal trainer.

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Mayo Clinic Q And A: Chest Pain Despite Normal Stress Test

DEAR MAYO CLINIC: What could cause chest discomfort or shortness of breath during exercise or other physical activity in women who have had a normal stress test?

ANSWER: Chest pain or shortness of breath that happens with exertion could be symptoms of a number of medical conditions even when the results of a stress test appear normal. The two most common stress tests are echocardiogram stress tests and nuclear stress tests.

An echocardiogram uses sound waves to make up images of the heart beating and pumping blood. For an echo stress, you walk on a treadmill to increase your heart rate, or you may be given medication that increases your heart rate. As your heart rate rises, the health care team monitors you to see if the heart muscle is pumping as strongly as it should.

If there is significant blockage in a blood vessel that leads to the heart a coronary artery the part of the heart muscle supplied by that vessel wont pump as vigorously as the other parts of the heart muscle around it. The stress echo images look at how the heart is pumping at rest compared to after the stress portion of the test. If the heart function is normal at rest but doesnt pump as strongly after the stress portion, this can also be a sign of underlying coronary artery disease.

Looking For The Wrong Thing

In recent years, Brown says doctors can more accurately diagnose heart attacks largely because of advances in the blood test that measures levels of a protein called troponin. High troponin levels signal injury to the heart.

This troponin test is super-sensitive, Brown says. But earlier blood tests were much less accurate. A patient could be having a heart attack and these older tests often would come back normal. Doctors didnt trust the tests, so they looked for other ways to evaluate the patient. CT scans and stress tests were among the methods used. But now that the blood testing method is so much better, there is less reason to continue doing these screening tests in the emergency room.

The investigators evaluated data from 1,000 patients who visited nine medical centers across the country that were a part of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography clinical trial. The current study revisited data from that trial, looking for any differences in outcomes for patients who received a clinical evaluation alone compared with those who received a clinical evaluation plus either a CT scan or a stress test .

In the study, 88 percent of patients received the extra testing. Nationwide, the overwhelming majority of patients evaluated for chest pain in the ER get such extra tests, Brown says.

Why hospital doctors should cut back on blood tests

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Whats Important To Know About Exercise Stress Testing In Women

People designated female at birth tend to experience heart disease differently than designated male at birth . This makes it challenging to detect early-stage heart disease. In general, healthcare providers tailor their stress testing and method of imaging during stress testing based on your sex and age to obtain optimal results and minimize radiation and unclear test results.

Recovering From Chest Pain

If your doctor has ruled out serious causes of chest pain, it is likely you will make a full recovery. General self-care suggestions include:

• Follow your doctors advice about treatment.
• In the first few days at home, try to take it easy.
• Rest if you feel tired.
• Slowly increase your activity, as you are able.
• There is no need to limit work or strenuous activity if you feel well.
• Follow up with your local doctor when recommended by your treating doctor.

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How Long Is A Stress Test

If youre undergoing a basic stress test, the exercise portion lasts about 10 to 15 minutes. Additional time is necessary for getting ready to exercise and recovering afterward.

Stress tests that include echocardiography, nuclear imaging or MRI often are longer and may require you to be in the stress lab for up to three hours.

When Do People With Chest Pain Need Imaging Tests

You may need an imaging stress test if:

• Your chest pain comes on with physical effort or emotional stress and goes away with rest, especially if youre a man over 40 or a woman over 50.
• You have an abnormal ECG and cant get an accurate interpretation during an ECG treadmill test.
• You cant exercise.
• You have a higher risk. For example, you are a smoker, or you have uncontrolled diabetes or high blood pressure.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

12/2012

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Q What Precautions I Must Take To Minimize The Chances Of Angina

• Avoid alcohol consumption and smoking.
• Change your eating habits and intake more of healthy food items that are low in fat and salt. Sources of protein like chicken, fish, soy are some good options.
• Keep a check on your blood pressure and cholesterol levels
• Exercise regularly but avoid extreme temperature and performing strenuous activities
• Keep yourself relaxed, calm, and manage your stress levels to avoid triggering anxiety or panic attacks

What Are The Different Types Of Stress Tests

There are many methods for assessing heart function while its hard at work. All cardiac stress tests involve checking your heart rate, blood pressure, oxygen levels and electrical activity. But there are some differences.

Stress test types include:

Exercise stress test

This is the most common and basic heart stress test. It involves walking on a treadmill or riding a stationary bicycle. A well-trained exercise physiologist usually tailors the speed and elevation of the treadmill to your ability to walk and your overall fitness.

If you cant exercise, you receive medications that make your heart pump harder and faster or dilate the artery supplying blood to your heart . An electrocardiogram captures your hearts electrical activity. Exercise stress tests check for signs of coronary artery disease.

Exercise stress echocardiogram

An exercise stress echocardiogram is similar to the basic stress test but provides more detail. Healthcare providers perform an echocardiogram before and at peak exercise. This cardiac imaging test uses sound waves to evaluate blood flow through your heart as well as the pumping chambers of your heart and valve functions.

You might need a stress echocardiogram if the results of your initial stress test are unclear. This study enables healthcare providers to observe blood flow through the hearts chambers as well as the effects of exercise.

Nuclear stress test

Nuclear cardiac stress tests can:

Cardiac rehabilitation stress test

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