While chest pain is classically associated with heart attack, there are certain things worth noticing.
Every chest pain is not a heart attack. On the same note, not every heart attack presents with chest pain. There always is some level of diagnostic uncertainty which doctors take into account before coming to a conclusion.
If we leave out uncommon scenarios, there are 2 common causes of potentially lethal chest pain. Heart attack is one, and blood clot in lungs (called pulmonary embolism) is another, with heart attack being much more common. Apart from these, many other causes of chest pain exists ranging from simple muscle pain which typically doesn't require any major intervention, to more significant ones that needs medical attention. Needless to say, any chest pain should prompt medical attention where lethal causes of chest pain must be evaluated and ruled out in a time sensitive manner.
A typical hospital course can be expected when someone presents to the emergency with chest pain. A physician takes detailed history of symptoms, assesses risk factors for heart attack, requests basic blood tests, electrocardiogram (ECG), special blood tests to look for signal of heart damage. Echocardiogram (ultrasound of the heart) and chest x-ray may be performed as well. Based on initial impression one of the following may happen:
1. Physician determines its a heart attack, a kind that requires immediate intervention either with clot dissolving medicine or angiography followed by angioplasty. Here, angiography is favored over medicines. Such kind of heart attack in technical term is referred to as STEMI (ST Elevation Myocardial Infarction). Here, time is muscle, which means sooner you intervene, more the heart muscle you will be able to save. We are talking about minutes here, not hours or days.
2. Its a heart attack, but not STEMI. This means medicines, ICU, followed by angiography after 1-2 days depending on patient's health status.
3. Its unclear if its a heart attack or not. In this case, few medicines are started (on the assumption that heart attack is present), and patient is reassessed periodically till a definitive diagnosis is made (typically about 24 hours).
4. Its not a heart attack but can be clot in the lungs (Pulmonary Embolism). Emergent CT scan is done to diagnose this problem.
5. Its neither heart attack, nor pulmonary embolism. Here onwards, medical decision becomes individualized and is different for different patients.
Another aspect is worth mentioning. Chest pain due to heart attack presents in many forms. Most commonly, its a dull aching sensation over the chest, at times confusing with 'gas' pain. Few people don't have chest discomfort, rather have discomfort of their upper back, neck, jaws etc. Due to varied symptomatology, and grave consequences of leaving a heart attack undiagnosed, it is always better to err on the side of caution and seek immediate medical attention if the above mentioned symptoms arise, particularly in males age 40 and above, or those who smoke or have diabetes. Worst case scenario, you will lose some of your time and money, but in return will get either a diagnosis or peace of mind that nothing significant is there.
I am sure I didn't address all the questions related to this topic. Please feel free to contact me with any of your queries and I will gladly answer those. Thanks
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