Patients entering the Emergency Department with chest pain are immediately placed in a protocol that will quickly identify if a patient is having a heart attack. The first step is giving the patient an electrocardiogram (ECG or EKG), a diagnostic tool that measures and records the electrical activity of the heart. The standard test is called a 12-lead electrocardiogram because it measures the electrical activity of the heart from 12 points of view. In a heart attack, part of the muscle dies and is electrically silent, no longer radiating energy. Interpretation of these detailed views allows diagnosis of a wide range of heart conditions.
The results of the ECG determine what happens next for the patient. If the ECG detects a heart attack, a very specific, structured plan of response is initiated that leads to the rapid selection of the proper treatment, according to Pat Wentworth, director of Emergency Services. For some patients, a clot-busting drug may be an appropriate way to treat their condition. Others will be sent to the cardiac catheterization lab for a diagnostic procedure. The ED’s goal is to administer the clot-busting drug within 30 minutes of arrival or to have the patient in the cath lab within 90 minutes.
“The cardiac cath lab is the gold standard of cardiac diagnostic tools,” Wentworth adds. “The procedure is safer and more effective than using a clot-busting drug.”
While the ECG can diagnose a heart attack, it can’t rule one out. When an ECG is inconclusive, the patient will undergo lab tests and observation for several hours until the lab tests are completed. If there is any concern for the patient’s heart, they will spend the night in the hospital and undergo a cardiac stress test.
“Even if a cardiac problem is ruled out, there are several serious health problems that mimic heart attack,” says Wentworth. Conditions that cause chest pain can originate from other organs in the chest, the chest wall, the spinal column or the abdomen. Chest pain is a common symptom of gastroesophageal reflux disease (GERD), a pulmonary embolism (blood clot in the lung), a perforated ulcer and in gall bladder disease. Even a cervical disk can irritate the nerve roots going into the chest wall and produce chronic chest pain.
No matter what condition causes chest pain, it is important to never ignore it. All chest pain should be checked out at your closest emergency department.