Nearly 6.5 million people visit America’s emergency rooms each year for chest pain. Additional millions of people seek out cardiologists to evaluate their chest pain, concerned they may be at risk for heart disease.
If that’s you, it’s important to know what to expect when you do see a cardiologist or undergo evaluation for chest pain. There are many causes of chest pain—some minor and some more serious—and testing can help point towards the cause.
You may expect your doctor to recommend a stress test. For the past 30 to 40 years, stress tests have been the main diagnostic test used by physicians to evaluate people complaining of chest pain. But within the past few years, studies have validated the use of computed tomography (CT) scans as an approach to determine the source of chest pain.
Here’s why and when a CT scan can be a helpful tool for those experiencing chest pain.
Why a CT scan for chest pain?
First, it’s important to realize that not all chest pain is from the heart. Some pain that happens with breathing, movement, etc. can be related to muscles or bones.
Additionally, not all heart pain is in the chest. Cardiac pain is often described as “discomfort” rather than pain. It could include pressure or tightness in the chest and/or in other areas including the shoulders, arms, neck, back, upper abdomen or jaw.
Since it’s often hard to tell heart pain from non-heart pain, it’s recommended that anyone experiencing the sudden onset of severe chest pain should call 911 immediately.
Reducing the guesswork with diagnostic testing
When someone presents with stable chest pain—that is, they are not having a heart attack—we would like to know if they have heart artery blockages. Knowing this helps doctors determine those patients who may require a heart catheterization versus those who simply require medications alone.
Stress tests have been used in the past to suggest the need for further invasive testing, but they have a high rate (up to 20%) of being in error. A good quality CT scan of the heart, a non-invasive procedure, can often tell us if a patient has mild blockage that requires only medicine, or if he or she has severe blockage that may require the placement of a stent or possibly open heart surgery.
There are still many people who need no testing, and many for whom a cardiac cath is the right next step. But CT scans can often help eliminate much of the guesswork because we can actually visualize a patient’s heart arteries directly. This can reduce the need for invasive procedures.
Is a cardiac CT scan right for you?
A CT scan isn’t the right diagnostic tool for everyone experiencing stable chest pain. People with irregular heart rhythms, poor kidney function, or who have a high body mass index may not be a good candidate for this test.
It’s important for you to know your options so you can have an informed conversation with your doctor about next steps.
About the author
Dr. Schussler is a general and interventional cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas and Baylor University Medical Center. His interests include preventative cardiology, coronary stents, trans-radial (through the wrist) coronary intervention. More recently, his research has focused on non-invasive coronary imaging using CT scans, as well as robotic-assisted angioplasty. He is active on Twitter @Updock typically posting on new technologies and techniques in cardiology.