Evaluation | Chest discomfort | Cardiology Made Clear with Dr. Freeman

← Chest discomfort: the short explanation

All 6 sections, including text and pictures · 26 pages

What should I do now?

Call 911

Call 911 for new or unexplained chest pressure that persists or returns, severe trouble breathing, collapse without normal recovery, or sudden face/arm weakness or trouble speaking. Do not drive yourself.

Contact your care team

New or changing chest symptoms need prompt assessment. Ongoing or recurrent concerning discomfort belongs on the emergency pathway.

Keep your care plan

For an established diagnosis, follow your written symptom plan and keep follow-up appointments.

Patient summaries & logs →

SECTION 4

Section 4: How is chest discomfort evaluated?

The first priority is to identify or rule out dangerous causes. Your care team will ask about your symptoms, examine you, and select tests based on your situation. Not everyone needs every test.

1. An EKG

An EKG records your heart’s electrical activity through patches placed on your skin. It can reveal rhythm problems or changes suggesting reduced blood flow.

A normal EKG alone does not rule out a heart attack or another heart-related cause of discomfort.

Patient receiving an EKG with electrodes on the chest and limbs. — An EKG is a quick, painless recording of the heart’s electrical activity.

2. Blood tests

When a heart attack is suspected, blood tests check for troponin, a protein released when heart muscle is injured. Testing may need to be repeated because changes can take time to appear.

Your team interprets these results together with your symptoms and EKG.

3. An echocardiogram

An echocardiogram, or echo, uses ultrasound to examine the heart’s pumping function and valves. It can help identify structural problems that may contribute to symptoms.

Patient getting an echocardiogram with an ultrasound probe over the left chest. — An echocardiogram uses sound waves to show the heart’s structure and pumping function.

4. A stress test

For selected patients, a stress test checks how the heart responds to increased workload.

You may walk on a treadmill or receive medication if exercise is not appropriate. Some tests include ultrasound or nuclear images to assess the heart’s function or blood supply.

A stress test is not a substitute for emergency evaluation of possible heart attack symptoms.

Patient walking on a treadmill during supervised stress testing with EKG electrodes and blood pressure monitoring. — A treadmill stress test monitors your heart’s response to exercise.

Patient lying under a cardiac nuclear imaging camera with a technologist supervising. — Nuclear stress testing uses a tracer and a special camera to compare blood flow at rest and during stress. Stress may be produced by exercise or medication.

5. Looking at the coronary arteries

Coronary CT angiography: A CT scan that examines the arteries supplying the heart.
Coronary angiography: A catheter procedure using contrast dye and X-ray images to identify narrowed or blocked arteries.

Your doctor chooses these tests when the findings could help guide treatment.

Patient having a coronary angiogram with the physician beside the sheath in the palm-up wrist. — A coronary angiogram uses contrast dye and X-rays to outline the coronary arteries. This example shows access through an artery at the wrist.

6. Testing for other causes

Chest X-rays or other scans may be needed to look for lung problems, blood clots, or problems involving the aorta.

If symptoms persist despite no major coronary blockage, selected patients may need further evaluation for coronary spasm or small-vessel dysfunction.

The goal is to explain your symptoms and choose the right treatment—not simply to order every available test.

Sources & further readingNIH: Angina treatment AHA: Heart attack warning signs Mayo Clinic: Chest pain evaluation and treatment NIH: Living with a stent

Updated October 2026. Educational information; your own care plan may differ. Medical illustrations are simplified examples for teaching.