Find out what you should do if ER testing finds nothing wrong with your heart despite chest pain and shortness of breath.

Chest pain is the No. 1 reason why people visit the emergency room. Shortness of breath is another leading reason for ER visits.

Typically, when a patient complains of chest pain with shortness of breath, they will be given a chest X ray, EKG and a blood test to track levels of an enzyme called troponin.

If troponin levels are increasing, this strongly suggests damage to the cardiac muscle: a heart attack, even a mild one.

The patient will be hooked up to a device that monitors heart rate, oxygen levels and blood pressure.

A doctor will listen with a stethoscope and feel the patient’s chest area. An EKG will be taken.

So imagine you have chest pain and trouble breathing, and all of these tests are normal.

What do you do next?

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“This totally depends on the patient – age, risk factors, how typical are the symptoms, physical exam, etc.,” says Monica Reynolds, MD, a cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.

“Symptoms can be due to GI problems, anxiety, muscular strain, infection, etc.

“If cardiac disease is suspected, the patient usually gets referred for a stress test at some point.”

Warning: The above-named ER tests may come back normal, and you can still have dangerously blocked coronary arteries.

The troponin test detects if you’ve had, or are currently having, a heart attack.

It does NOT detect how much blockage is in your coronary arteries. Neither does a chest X-ray.

Though a doctor can tell a lot by listening with a stethoscope, this device cannot detect severely clogged coronary arteries.

An EKG test can be telling of heart disease, but some EKG readings can’t be read well (for possible severe heart disease) due to a “bundle branch block.”

If your ER tests are normal even though you have chest pain and shortness of breath, be very careful about what you decide to do next.

Your health history and absence or presence of risk factors for heart attack should weigh heavily into what should be done next.

Studies show that an MR angiogram, during the ER visit, is a reliable test for detecting severe heart disease in those with chest pain but with low risk factors for coronary artery disease.

Since 1992 Dr. Reynolds has practiced clinical cardiology at ColumbiaDoctors Medical Group, one of the largest multi-specialty practices in New York State.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer. 


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