Chest Pain in the Emergency Department: How Doctors Rule a Heart Problem In or Out

KUWAIT CITY, Oct 27: Chest pain is one of the most common reasons people visit an emergency department, and one of the most worrying. The good news is that most chest pain turns out not to be a heart attack. The challenge for doctors is to identify, quickly and safely, the minority of patients whose pain is cardiac. Knowing how they do it can make the hours in the department less frightening.

On arrival, chest pain is treated as a priority. A nurse records your heart rate, blood pressure and oxygen levels, and an ECG is usually done within about ten minutes. The ECG looks at the heart's electrical activity. Certain patterns signal a heart attack caused by a completely blocked artery, and these patients go straight to the catheterisation lab for emergency treatment.

For everyone else, the work continues.

A protein called troponin is released into the blood when heart muscle is damaged. Modern high-sensitivity tests can detect very small amounts. Because levels take time to rise, doctors usually repeat the test after one to three hours. A normal or stable result over that period makes a heart attack much less likely; a rising level suggests damage.

Doctors combine the ECG and troponin results with your history: what the pain felt like, how long it lasted, what brought it on and whether you have risk factors such as diabetes, high blood pressure, smoking, high cholesterol or a family history of heart disease. Many departments use structured risk scores to decide who can go home safely, who needs further tests and who needs admission.

An echocardiogram is an ultrasound scan of the heart. In the emergency setting, a quick bedside echo can show whether part of the heart muscle is moving poorly, which can point to a heart attack. It can also reveal other serious causes of chest pain, such as fluid around the heart or strain on the right side of the heart from a clot in the lungs. A fuller echo is often arranged later to assess the valves and overall pumping function.

Not every serious chest pain comes from the coronary arteries. Doctors also think about a clot in the lungs (pulmonary embolism), a tear in the aorta (aortic dissection), a collapsed lung and inflammation of the heart lining. CT scans are used when these are suspected. Common non-serious causes include muscle strain, acid reflux and anxiety.

If tests are reassuring, you may be discharged with advice and an outpatient appointment. That might include a stress test, a CT coronary angiogram or a full echocardiogram to look for underlying heart disease. Return immediately, or call 998, if pain comes back, becomes more severe or is accompanied by breathlessness, sweating or fainting.

Describe when the pain started, what you were doing, what it feels like and whether it spreads anywhere. Mention any previous heart problems, recent surgery, long flights or periods of immobility, and every medicine you take. Women and people with diabetes are more likely to have atypical symptoms, such as breathlessness, nausea or exhaustion without obvious chest pain, so mention these even if they seem unrelated.

If you suspect a heart attack, call 998 for an ambulance in Dubai. Paramedics can take an ECG on the way and alert the hospital, giving the medical team time to prepare for treatment before you arrive.

It helps to know in advance which nearby hospitals provide 24/7 heart emergency care in Dubai, with a catheterisation lab team available at night and at weekends, not only during office hours.

Aster Hospitals runs 24-hour emergency departments across its Dubai hospitals in Mankhool, Al Qusais and Muhaisnah and at Aster Cedars Hospital & Clinic in Jebel Ali. Aster Hospital Al Qusais lists a 10-bed emergency department and a cardiac catheterisation lab.

Patients who are referred for an echo test in Dubai can have 2D, 3D, Doppler or stress echocardiography within the group's cardiology services, and Aster Cedars Hospital & Clinic offers echo and treadmill testing on site.

Chest pain can be frightening, especially when you do not know whether it is coming from the heart. Doctors use ECGs, blood tests and, when needed, scans to find the cause and decide what care you need.

Knowing how chest pain is assessed can ease some of the uncertainty during an emergency, but never delay seeking medical help if you suspect a heart attack, and never wait for symptoms to settle if a heart attack is possible.