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How is Chest Pain Diagnosed?

The key to diagnosing chest pain is history. Learning about the nature of the pain will give the healthcare provider direction as to what are reasonable diagnoses to consider, and what are reasonable to exclude. Understanding the quality and quantity of the pain, its associated symptoms and the risk factors for disease, can help the care provider assess the probability of what potential diagnoses should be considered and which should be discarded.

Differential diagnosis is a thought process that healthcare providers use to consider and then eliminate potential causes for an illness. As more information is gathered, either from history and physical examination or testing, the potential diagnosis list is narrowed until the final answer is achieved. As well, the patient's response to therapy can expand or narrow the differential diagnosis list. In patients with chest pain, many potential diagnoses may exist, and the healthcare provider will want to first consider those that are life-threatening. Tests to rule out heart attack, pulmonary embolus (a clot in the lung), or aortic dissection (tear in the aorta) may not be necessary; when clinical skill and judgment may be all that is needed to consider or discard a diagnosis.

You may be asked a variety of questions to help the healthcare provider understand the patient's pain. Patients use different words to describe pain, and it is important that the healthcare provider get an accurate impression of the situation.  The concept of ruling out a diagnosis is difficult for some patients to understand. Instead of proving what is happening, the healthcare provider is sometimes charged with proving that a life-threatening diagnosis is not present. "Proving what isn't" takes time and technology. A combination of blood tests and imaging studies may take hours to confirm or refute a diagnosis.



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