Chest pain can be associated with a variety of medical disorders. It can have a cardiac basis, meaning that it is related to heart, or it can be a sign that there is a problem in another body system, such as lungs or gastrointestinal tract. The best way to determine the cause of chest pain is to be seen by a qualified physician. Chest pain can signify a life threatening condition, so it is best to have it evaluated promptly.

The pain associated with a heart attack differs from person to person. Many people describe it as a heavy pressure or squeezing sensation in the center of their chest. Others report a burning or stabbing feeling. At times the pain may radiate to the arm, jaw, or back. The intensity of the pain is not an indicator of the degree of heart damage that may be occurring. Some people experience no symptoms during a heart attack.

A characteristic of chest pain associated with a heart attack is that it is often unrelenting. Once it begins there is usually nothing that a person can do at home to stop it. The pain does not improve with rest, position changes, or over-the-counter medications.

Frequently, patients experiencing a heart attack, or myocardial infarction as it is called in the medical community, describe other symptoms associated with the chest pain. These may include sweating, dizziness, shortness of breath, palpitations, paleness, nausea and vomiting, and an anxious feeling with a sense of impending doom.

When the patient arrives at the emergency room of a hospital, a nurse or physician will ask some questions about the symptoms that the patient is experiencing. A physical examination will be performed. The patient will be placed on a heart monitor so that the heart rhythm can be continuously observed. Frequently during a heart attack (myocardial infarction), the heart's electrical system is interrupted, and this interruption can result in serious heart rhythm disturbances.

An intravenous catheter will be inserted into the arm. This provides access for the administration of fluids and medications. The patient may be given supplemental oxygen through the nose or mouth. This is necessary during a heart attack to deliver needed oxygen to the body.

A series of tests will be performed to help the physician in making the diagnosis of a heart attack. An electrocardiogram (ECG) can determine if the heart is being deprived of oxygen, and if the patient is truly having a heart attack. At times, the ECG appears normal even when a heart attack is occurring. Changes on the ECG may not be apparent for several days. For this reason, the physician may recommend admission to the hospital for continued observation.

Blood tests can provide important information about heart muscle damage during a heart attack. When heart muscle dies, an enzyme called creatinine phosphokinase (CPK) is released into the blood stream. A special form of CPK, which is found only in heart tissue, can be measured. Another chemical, which is becoming more widely used to diagnosis a heart attack is troponin T, also found only in cardiac muscle cells. These blood tests will usually be repeated every 8 hours for the first few days following a heart attack. They provide useful information about the degree of damage and when the heart attack may have first occurred.

For a few days following a heart attack, patients are observed in a special area of the hospital called the cardiac care or intensive care unit (CCU or ICU). During this time, physical activity and visitors may be restricted and patients are encouraged to rest. Special monitoring devices are used to help the medical team identify and treat any complications that may occur.

For many people, a heart attack is the first sign that they have coronary artery disease. Before a patient is discharged from the hospital, he or she will often undergo another series of diagnostic tests to assist the physician in evaluating the extent of the heart disease. Some examples of these tests include:
Cardiac catheterization
During this test, a small catheter is inserted through a vein or artery in the arm or leg and then guided into the coronary vessels of the heart. Information can be obtained about the patency of the coronary arteries, the condition of the heart muscle and the heart valves themselves, and the amount of oxygen that the heart is receiving. Dye may be used to enhance visualization during this test. The test is not painful, but some patients report a warm sensation when the dye is injected.

Angioplasty
If thrombolytic agents were not given or did not relieve the heart attack symptoms, physician may decide to perform angioplasty. Angioplasty can be done during a cardiac catherization. It involves the placement and blowing up of a small balloon at the site of a coronary artery blockage. The balloon can cause the vessel to stretch or it can compress the area of blockage, with the end result of increasing blood flow to the heart. At times, a stent is also placed in the vessel to prevent it from collapsing or from having a blood clot form at the site of the blockage.

Coronary artery bypass grafting (CABG)
If angioplasty is not indicated, either because of the site of the blockage or the degree of blockage present, the physician may recommend bypass surgery. This procedure involves a major surgical operation where a portion of a vein taken from the patient's leg, or an artery taken from the chest, is used to enable blood to flow around the blockage. If needed, several areas of blockage can be bypassed during this procedure. This surgery involves splitting the chest bone to gain access to the heart. Hospital stays vary but usually last at least 1 week.

Following discharge from the hospital, patients continue their recovery at home. It is not unusual for the physician to prescribe medications that will be needed to take on a daily basis. These medications will vary, depending on the extent of heart disease and other existing medical conditions. It is important to take the medication as directed and to report any unusual side effects to physician.

Activity may be restricted initially. Before leaving the hospital the physician will discuss limitations regarding employment and sexual activity. The treatment plan may include modifications to diet and exercise. Quitting smoking is necessary.