Coronary artery disease and diminished blood flow to the heart muscle is the primary cause of heart attacks and heart disease is by far the leading cause of death in the US. A most common and frequent symptom of a heart attack is chest pain. Several risk factors for heart attack have long been recognized. Tobacco use, failure to control cholesterol, heart arrhythmias and blood pressure are treatable and controllable.
Other medical problems that can be life-threatening can also cause chest pain. These include pulmonary embolism and aortic aneurysm dissection. Death or long-term disability can result from medical mistakes in diagnosing, evaluating and treating a patient’s complaint of chest pain. Evaluation of chest pain and a heart attack starts with an EKG and cardiac monitoring for arrhythmia detection, laboratory blood testing for evidence of heart muscle damage, and an appropriate physical examination. The clinician’s judgment is important in judging the exact diagnosis and at times despite negative EKG or lab test results the early evolution of a heart attack may require monitoring and observation along with other testing to understand the cause of chest pain.