chest pain

If you go to the ER for chest pain, you won’t be given a CT scan of your heart just because of your symptom.

And if you do get one, it won’t be to check for a heart attack as the cause of the chest pain.

“There are two types of CT angiogram that could be performed in the ER for chest pain — CT pulmonary angiogram and CT coronary angiogram,” says Resham Mendi, MD, a renowned expert in the field of medical imaging, and the medical director of Bright Light Medical Imaging.

“A CT pulmonary angiogram would be done if the doctor thinks that there is a risk for pulmonary embolism (blood clot in the pulmonary artery). This is frequently done in emergency rooms.”

The doctor may refer to the procedure as just a “CT scan” when speaking to the patient or family member.

However, it requires an injected contrast dye to show the blood vessels.

A kidney test is done to make sure the patient’s kidneys are healthy enough to tolerate the contrast dye.

This imaging study will look at the lungs, not the heart.

A complaint of chest pain will net a blood test called D-dimer which can indicate the presence of a blood clot somewhere in the body.

This is why the pulmonary angiogram is ordered, because a blood clot in the lung can cause chest pain.

D-Dimer Is Negative, so Why Not a CT Angiogram for the Chest Pain?

“A CT coronary angiogram is done to look for blockage in the coronary arteries which could cause a heart attack,” says Dr. Mendi.

“This is not typically done in the ER because of the urgent nature of heart attacks.

“If there is concern for heart attack, they usually do EKG and blood tests in the ER as a quick way to look for abnormalities.

“If more evaluation is needed, they would rather do a traditional coronary [catheter] angiogram rather than a CT coronary angiogram.

“This is because during a traditional coronary angiogram, if the cardiologist sees a blockage, they can open it up right away while they are looking at it.  This cannot be done in a CT coronary angiogram.”

The traditional or catheter angiogram carries a risk of stroke and heart attack, though these complications are rare.

Nevertheless, due to these risks, this gold-standard procedure is reserved for patients whom doctors are pretty convinced have serious blockages.

If the blockage can be treated with a stent, the stent placement can be done right on the spot during the catheter procedure.

The doctor may also determine that bypass surgery is the only viable treatment. The patient may then be prepped on the spot for emergent surgery.

You can now see how a CT angiogram would be an extra, burdensome step that would potentially delay things – which is why currently, it’s not a routine procedure in the ER to evaluate chest pain – especially in patients at low risk for coronary artery disease.

dr. mendiDr. Mendi has published several articles in radiology journals and has expertise in MRI, women’s imaging, musculoskeletal, neurological and body imaging.