When a patient presents with chest pain the possibilities for different diagnoses are present. There is a need to correctly assess the nature of the chest pain in order to give the best treatment possible.

Differential diagnosis is a method of evaluation used by the doctors to consider a potential diagnosis and then to eliminate it after suitable assessment. The first step toward evaluating chest pain is to rule out heart attack (myocardial infarction), pulmonary embolus, and aortic dissection. Towards this the medical history is documented by putting forward necessary questions to the patient.

Alongside this a clinical examination is also carried out. This is followed by an ECG and a blood test. If these steps show negative, further tests have to be conducted.

Rapid diagnosis of heart problem is necessary to rule out potential heart damage.

If life-threatening reasons are ruled out then the patient is observed for a while and referred back to the physician. In case of chronic and recurrent chest pain the primary suspect is angina arising from Coronary Artery Disease (CAD). It is important to take angina seriously as this could indicate CAD- a disease that could lead to a heart attack, stroke or even death.

In this case Coronary Angiogram or Cardiac Catheterization or Stress Testing using thallium may be necessary.

If chest pain is not due to the usual heart related diseases, then X rays, pulmonary function test or GI Endoscopy might be required depending upon the discretion of the doctor.

Some of the common diagnostic tests that may be carried out to detect the causes of chest pain include:-

• Blood tests (complete and differential blood count, tests for LDH &its isoenzymes, CPK & its isoenzymes, troponin)
• ECG, exercise ECG
• X-rays of the chest
• Lung scan
• Cardiac Catheterization