How do doctors investigate chest pain that is becoming more frequent?

Doctor's Answers 1

Patients may complain of chest pain to their family physician, who may then refer you to a cardiologist depending how his/her initial assessment of you.

A good and detailed history followed by a focused physical examination by your doctor is the first step in the initial assessment of chest pain. This not only allows the physician to assess your pre-test probability that the chest pain is due to coronary artery disease, it also allows the physician to determine the next course of relevant investigations that is appropriate for the individual patient. Some patients with pre-existing cardiovascular risk factors like hypertension, diabetes, high cholesterol, smoking history, significant family history of heart diseases have increased likelihood that the chest pain could be due to coronary artery disease.

Some of the more alarming features of chest pain that could be due to significant coronary artery disease are (but not limited to): chest pain/discomfort that occurs on physical exertion or during emotional stress or during/after a meal; shortness of breath associated with chest pain; light headedness during chest pain; breaking out in cold sweats or feeling nauseous during chest pain; palpitations associated with chest pain; chest pain resulting in fainting.

Some of the investigations (in no particular order) that can be done for a patient with chest pain complaints can be broadly divided into non invasive and invasive.

For non invasive:

  • Electrocardiogram (ECG)
  • Echocardiogram (2DE)
  • Functional assessment (e.g. Treadmill, Stress Imaging)
  • CT coronary angiogram with calcium score

For (minimally) invasive:

  • Coronary angiogram +/- fractional flow reserve (FFR) assessment
  • Coronary angioplasty (if angiogram detected a significant blockage in the coronary artery)

Do see your cardiologist early if your chest pain is becoming more frequent so that he can determine if you have a potentially treatable heart condition.

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