Chest Pain: When to Worry, When to Wait, and How a Cardiologist Thinks About It

If you're reading this with chest pain happening right now, and any of the following are also true, stop reading and call 911. The pain is severe. You're sweating. You feel sick to your stomach. You're short of breath. The pain is radiating into your jaw or down your arm. You feel lightheaded or like you might pass out. You've had heart problems before. None of those are things to talk yourself out of, and none of them are appropriate to drive yourself in for. The reason an ambulance matters is that paramedics can do a 12-lead EKG in your living room and call ahead to the cath lab so the team is ready when you roll through the door. Time is heart muscle. Help arriving fast saves it.

For everyone else reading without active emergency symptoms, this article is the long version of the conversation I have many times a week in clinic. I'm Dr. Damian Rasch, a cardiologist in Encinitas. People come in with chest pain that ranges from a few seconds of sharp twinges to a deep, heavy pressure that's been there for weeks. Most of them are worried they're having or about to have a heart attack. Most of them turn out not to be. The job of this article is to give you the framework I use to think about chest pain so you can decide which bucket your symptom probably falls into and what to do next. It is not a substitute for being seen, especially if you have any cardiovascular risk factors or any of the high-risk features I'll describe below. But it should help you make a more informed decision about how urgent that evaluation needs to be.

What Cardiac Chest Pain Usually Feels Like

Classic cardiac chest pain has a recognizable shape, and it's worth describing in some detail because the pattern is more useful than any single feature. The pain sits in the middle of the chest, sometimes a little to the left, and patients usually describe it not as sharp but as pressure, squeezing, heaviness, or a band tightening around the chest. A common description is the sensation of an elephant sitting on the chest, or of a heavy weight pressing down. Another common one is "it doesn't really hurt, it just feels wrong." Some patients have no actual pain at all, just a fullness or discomfort that they can't quite name.

Classic cardiac chest pain comes on with exertion. Walking uphill, climbing stairs, carrying groceries from the car, or pushing a vacuum can bring it on. It tends to come on consistently with the same level of activity, which is why we use the term stable angina for chest pain that has a predictable threshold. The pain gets better with rest, usually within a few minutes of stopping the activity. It can radiate to the jaw, the neck, the left arm, both arms, the upper back, or even the upper abdomen. Patients sometimes describe a tooth ache, a sore throat, or indigestion that turned out to be cardiac. The radiation pattern is one of the more useful features. Pain that travels in a recognizable territory is more likely to be cardiac than pain that stays localized in one spot.

If your symptom matches that pattern, you should be evaluated, and the question is how urgent. The next several sections are about that question.

When Cardiac Chest Pain Doesn't Look Classic

One of the hardest lessons in cardiology is how often heart disease presents in atypical ways, and how often that atypical presentation gets missed. Three groups in particular tend to present without the classic pattern: women, diabetics, and older patients.

Women often present differently than men. Women with acute coronary syndromes may report jaw pain, back pain between the shoulder blades, nausea, severe fatigue without an obvious chest component, palpitations, or shortness of breath as the dominant symptom. The VIRGO study, which followed women under 55 hospitalized with heart attacks, showed that more than 60 percent had at least one symptom that wasn't chest pain, and many delayed coming in because what they were feeling didn't match the picture they had in their head. The lesson from VIRGO and from decades of similar data is that any new constellation of unexplained symptoms in a woman with cardiovascular risk factors should be taken seriously, even if chest pain is not the chief complaint.

Diabetic patients also tend to have less typical symptoms. Diabetic neuropathy can blunt the pain signal from the heart, which means a diabetic patient may experience a heart attack as new shortness of breath, fatigue, sweating, nausea, or vague upper-body discomfort without the classic crushing chest pain. The threshold to think cardiac in a diabetic patient with new symptoms is low. I'd rather work up ten patients with reflux than miss one heart attack in a diabetic.

Older patients, especially those over 75, frequently present with confusion, weakness, falls, or fainting rather than chest pain. The cardiac event may be silent, with the only clue being a sudden change in mental status, a fall in functional capacity, or a syncopal episode. Family members are often the first to notice that something is off. In an older patient with a sudden change in baseline, a cardiac workup is part of the standard evaluation.

The common thread across all three groups is that the textbook presentation is not the only presentation, and the cost of dismissing atypical symptoms is much higher than the cost of evaluating them.

When the Chest Pain Is Probably Not Your Heart

Several patterns suggest the pain is coming from somewhere other than your coronary arteries. None of these are a guarantee, and any new chest discomfort deserves a thoughtful evaluation, but the patterns can help you decide whether to call your doctor versus head to the ER.

Reflux (GERD) is one of the most common mimickers. The pain is usually a burning sensation behind the breastbone, often worse after eating, often worse when lying flat, and often accompanied by a sour taste in the back of the throat. It's relieved by antacids, by sitting up, or by drinking water. The challenge is that GERD can mimic cardiac pain very closely, including being substernal, pressure-like, and radiating. A trial of acid-suppressing therapy is sometimes used as a diagnostic test, but it's not a substitute for excluding cardiac causes when risk factors are present.

Musculoskeletal pain is the most common cause of chest pain in primary care. It tends to be sharp or stabbing rather than pressure-like, often reproducible by pressing on the chest wall, worse with twisting, deep breathing, or specific arm movements. There's often a recent history of physical exertion involving the upper body, a recent injury, or a new exercise routine. Anti-inflammatory medication and rest usually resolve it over days to a couple of weeks. Costochondritis is the most common subtype: inflammation of the cartilage where the ribs meet the sternum, reproducible by pressing on the rib joints, often worse with deep breathing or exercise.

Pericarditis is sharp, positional pain that's usually worse lying down and better sitting forward. It often follows a viral illness by a few days to a couple of weeks. The pain can radiate to the trapezius ridge, which is somewhat specific. On exam, a friction rub may be heard, and the EKG often shows diffuse ST elevation with PR depression that's different from the focal changes of a heart attack. Pericarditis is cardiac in origin but is not a coronary problem and has its own management, usually with an NSAID and colchicine.

Anxiety and panic attacks can cause chest tightness, shortness of breath, dizziness, tingling in the fingers and around the mouth, and a sense of impending doom. The episode usually has a recognizable trigger or context (an argument, a stressful situation, a fear-provoking thought) and resolves over 10 to 20 minutes regardless of position or activity. The challenge is that anxious patients also have heart disease, and the chest pain of anxiety is real even when no coronary cause is found. A baseline cardiac evaluation, especially in patients with risk factors, helps both the patient and the treating clinician approach future episodes with more confidence.

Pulmonary causes like pleurisy, pneumonia, and bronchitis can cause chest pain that's worse with breathing in. The pain often has a sharp, knife-like quality and may be associated with cough, fever, or recent respiratory illness. Pneumothorax (a collapsed lung) causes sudden sharp one-sided chest pain with shortness of breath, classically in tall thin young men or in patients with underlying lung disease.

If your symptom pattern fits one of these categories, that's reassuring but doesn't replace a clinical evaluation, especially if you have any cardiovascular risk factors (high blood pressure, high cholesterol, diabetes, smoking history, family history of early coronary disease, prior heart events).

The Dangerous Mimickers

A few non-coronary causes of chest pain are themselves life-threatening and need to be on the radar. They don't always cause classic symptoms, and the consequence of missing them is sometimes worse than the consequence of missing a heart attack.

Aortic dissection presents as sudden, severe, tearing chest pain that often radiates to the back between the shoulder blades. Patients describe it as the worst pain of their life. Blood pressure may differ between arms, the carotid pulses may feel asymmetric, and a new diastolic murmur of aortic insufficiency may be heard if the dissection involves the root. Risk factors include longstanding hypertension, connective tissue disease (Marfan, Ehlers-Danlos vascular type), bicuspid aortic valve, prior aortic surgery, and recent extreme exertion or trauma. This is a surgical emergency. The diagnostic test is a CT angiogram of the chest. The treatment for ascending dissection is immediate surgery; the treatment for descending dissection is aggressive blood pressure control with selective surgical or endovascular intervention. Call 911.

Pulmonary embolism presents with sudden shortness of breath, sometimes with sharp chest pain that worsens with breathing, sometimes with cough or hemoptysis, and often with leg swelling on one side from a deep venous thrombosis. Risk factors include recent surgery (especially orthopedic), prolonged immobility (long flights, long drives), cancer, hormone therapy or oral contraceptives, pregnancy and postpartum, prior DVT or PE, and inherited thrombophilias. Massive PE can cause shock, syncope, and cardiac arrest. The diagnostic test is usually a CT pulmonary angiogram. Treatment ranges from anticoagulation alone for stable PE to systemic thrombolysis or catheter-directed therapy for massive or submassive PE.

Esophageal rupture (Boerhaave syndrome) is a tear in the wall of the esophagus, usually after forceful vomiting. It causes severe chest or upper abdominal pain, often with subcutaneous emphysema (a crackling sensation under the skin of the neck or chest) and signs of mediastinitis. It's rare but carries high mortality if missed.

Severe pancreatitis can present as upper abdominal pain that radiates to the chest or back. Risk factors include alcohol use and gallstones. Lipase is elevated, and CT or ultrasound confirms the diagnosis.

Tension pneumothorax is a collapsed lung that has progressed to the point where air is accumulating under pressure in the chest, shifting the mediastinum and impairing venous return. It causes severe shortness of breath, hypotension, and sometimes cardiac arrest. Treatment is needle decompression followed by chest tube placement.

The shared feature of these conditions is that they tend to come on suddenly, the pain tends to be severe, and there are usually accompanying signs of physiologic distress. A careful history and exam in the emergency department will pick most of them up, but the threshold to consider them needs to be low when the presentation is severe or atypical.

When to Call 911 Versus Schedule a Visit

The single most useful question I can answer for a patient is: how urgent is this? The answer depends on what the pain feels like, how long it's been going on, what other symptoms are present, and what your underlying risk profile looks like.

Call 911 immediately if you have chest pain that lasts more than 15 minutes at rest, that's associated with sweating, nausea, vomiting, lightheadedness, or shortness of breath, that radiates to your jaw or neck or arm, that's severe and tearing (especially if it radiates to the back), that wakes you from sleep, that comes with a sense of impending doom, or that comes with palpitations or fainting. The reason to call rather than drive is that paramedics can begin treatment in the field and call ahead to the receiving hospital. For STEMI (the kind of heart attack with a complete artery blockage), every 30 minutes of delay between symptom onset and reperfusion costs heart muscle. The minutes you spend driving yourself in are minutes you can't get back.

Go to an emergency department or urgent care promptly (within hours) if your pain is new and you have cardiovascular risk factors (over 50, diabetes, hypertension, smoking history, family history of early heart disease), if it comes on consistently with exertion and goes away with rest (this pattern, called stable angina, needs urgent outpatient workup), or if it's changing in pattern, becoming more frequent, more severe, easier to provoke, or coming on at lower workloads than before. Chest pain that's stable for years and unchanged today is different from chest pain that's been escalating over the last week. The change is the clue.

Schedule a primary care or cardiology visit within days for brief, atypical chest discomfort that resolves on its own, for recurrent chest discomfort with clear non-cardiac features (positional, reproducible by pressing, after meals), for anxiety-related chest tightness without other cardiac risk factors, or for chest discomfort that you're trying to characterize and aren't sure how to interpret. A cardiologist or primary care doctor with appropriate testing can usually sort out within a single visit what kind of pain you have and what the next step should be.

When in doubt, err toward urgency. The cost of going to the ER and being told it's not your heart is much smaller than the cost of staying home with an evolving heart attack. ER doctors do not roll their eyes at patients who come in with chest pain that turns out to be benign. Evaluating chest pain is one of the things ERs are best at, and a quick workup takes a couple of hours and is genuinely reassuring when it's negative.

What Happens in the Emergency Department

If you go to the ER for chest pain, you'll get a fairly standard workup, and the timeline is reasonably predictable. Within minutes you'll have a 12-lead EKG, a blood draw including a cardiac enzyme called troponin, IV access, and a focused history and exam. The EKG can identify a major heart attack within seconds. If the EKG shows ST elevation in a vascular territory pattern, the ER doctor activates the cath lab, and the goal is to get you on the angiography table within 90 minutes of arrival. That speed is what saves heart muscle. STEMI care in the United States has gotten extremely good at meeting that 90-minute door-to-balloon target, and outcomes have improved enormously over the last two decades because of it.

Most chest pain in the ER doesn't show an obvious heart attack on the first EKG. The next step is risk stratification, which is the process of figuring out whether you're at high enough risk for a cardiac event in the near future to warrant admission and further testing, or low enough risk to go home with outpatient follow-up. Most ERs now use the HEART score, which combines history, EKG findings, age, risk factors, and troponin level into a number from 0 to 10. Scores 0 to 3 are low risk for a major cardiac event in the next six weeks (under 1 percent), and those patients often go home with outpatient follow-up. Scores 4 to 6 are intermediate risk and usually trigger additional testing such as a stress test or coronary CT angiogram before discharge. Scores 7 to 10 are high risk and usually mean admission and either invasive evaluation or aggressive medical management.

High-sensitivity troponin assays, now standard in most US hospitals, allow much faster rule-out than the older troponin tests. A negative high-sensitivity troponin at zero and one hour can rule out a heart attack with very high confidence in low-risk patients. This has dramatically shortened ER stays for patients whose chest pain turns out to be benign, and it's part of why the ER is the right place for new chest pain even when you suspect it's not your heart.

For intermediate-risk patients, the 2021 AHA/ACC chest pain guideline gives a strong endorsement to coronary CT angiography (CCTA). This is a contrast-enhanced CT scan that shows the coronary arteries directly. A clean CCTA in a patient with chest pain is highly reassuring and can avoid the need for a stress test or catheterization. A CCTA showing significant stenosis often goes directly to invasive angiography. The CCTA has become the test of choice for stable chest pain in many centers and is increasingly used in the ER for risk stratification of acute presentations.

If admission is required, the inpatient workup typically includes serial troponins, an echocardiogram to assess wall motion and ventricular function, and often a stress test or coronary angiogram before discharge. The stay is usually one to three days for uncomplicated cases.

Outpatient Workup After Reassurance

If you've been to the ER and were sent home, or if your chest pain didn't seem urgent enough for the ER, a cardiology workup might still be appropriate. The goal of the outpatient workup is twofold: to characterize whether you have coronary artery disease, and to estimate your overall cardiovascular risk so we can build a prevention plan.

A cardiology consultation usually starts with a careful history and physical exam, which is more diagnostic than it sounds. The history alone often differentiates classic angina from atypical chest pain or noncardiac pain. The exam includes a careful cardiovascular exam looking for murmurs, gallops, signs of heart failure, and peripheral vascular disease, plus blood pressure measurements in both arms and a palpation of all major pulses.

Standard labs include a lipid panel, fasting glucose or A1C, basic chemistries, and often Lp(a), apo B, and high-sensitivity CRP for risk stratification. A coronary calcium score is an excellent test for refining risk in selected patients, especially those whose risk is borderline by traditional calculators. A score of zero is highly reassuring; a score above 100 changes the prevention plan; a score above 400 puts the patient in a high-risk category that often warrants imaging or even invasive evaluation.

The next step depends on your symptom pattern and risk level. For patients with classic exertional chest pain and intermediate to high pre-test probability of coronary disease, a stress test is the usual next move. The choice of stress test depends on your ability to exercise, your baseline EKG, and your body habitus. A treadmill stress EKG is the simplest and least expensive but has limitations in patients who can't exercise, who have an abnormal baseline EKG, or who have intermediate pre-test probability where additional imaging will improve diagnostic accuracy. A stress echocardiogram or a nuclear stress test (myocardial perfusion imaging) adds imaging to the protocol and is more sensitive for ischemia. A pharmacologic stress test (with dobutamine or a vasodilator) is used when the patient can't exercise.

Coronary CT angiography is increasingly used as a first-line test, especially in patients without significant calcified plaque on the calcium score. CCTA gives anatomic information about the coronary arteries in a way that stress tests don't, and it's especially useful in younger patients and women in whom stress tests have lower diagnostic accuracy.

For patients whose chest pain is suspected to be non-cardiac, the workup pivots to gastroenterology for reflux (often with empiric PPI trial, sometimes with esophageal pH or motility studies), to musculoskeletal evaluation (physical exam, targeted physical therapy), or to psychiatric evaluation if anxiety or panic is the primary driver. The non-cardiac evaluation is just as important as the cardiac one, because chronic chest pain that goes unexplained tends to keep generating ER visits and patient anxiety.

MINOCA: When the Arteries Look Clean

A growing area of cardiology is recognizing that some patients have heart attacks without a major blockage on angiogram. This is called MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries). It accounts for up to 10 percent of heart attacks and is more common in women, where it can account for 25 percent or more of cases.

The mechanisms of MINOCA include plaque erosion (a small plaque ruptures even though it didn't look severe enough to cause symptoms), coronary spasm, spontaneous coronary artery dissection (SCAD, more common in young to middle-aged women, especially in the postpartum period or in patients with fibromuscular dysplasia), microvascular dysfunction, embolic events, and various non-coronary causes of myocardial injury that masquerade as MI. The workup often includes cardiac MRI to look for scar pattern (which can identify infarction, myocarditis, or stress cardiomyopathy), intravascular imaging during catheterization to assess for plaque erosion or dissection, and provocative testing for coronary spasm in selected centers.

The point for patients: a clean angiogram does not always mean your symptoms aren't real, and it does not always mean you didn't have a true myocardial infarction. If your chest pain is genuine and the standard workup is unrevealing, ask about microvascular testing, cardiac MRI, or referral to a center that specializes in MINOCA evaluation. Treatment differs by mechanism, and patients with MINOCA still benefit from aggressive risk-factor modification.

Common Patient Questions

My pain only lasted a few seconds. Could that still be my heart?

Cardiac chest pain typically lasts at least several minutes. Brief sharp pains lasting a second or two are usually musculoskeletal or related to nerve sensitivity in the chest wall. They're rarely cardiac. The exception is a brief sharp pain that recurs many times over hours or days, especially with exertion, which deserves evaluation. A single isolated pang of a few seconds, especially one that's reproducible by movement or position, is almost never cardiac.

I felt the pain when I was at rest, not exercising. Does that rule out my heart?

No. Pain at rest can be cardiac, and is sometimes more concerning than exertional pain because it suggests an unstable plaque rather than a stable narrowing. The textbook teaching is that exertional pain that resolves with rest is stable angina, but pain that comes on at rest, especially if it's new, prolonged, or severe, is unstable angina or potentially an acute coronary syndrome. Don't use rest versus exertion as a rule-out. Use the totality of features: how long it lasted, what it felt like, what associated symptoms were present, and what your risk profile looks like.

My EKG and troponin were normal in the ER. Am I safe to go home?

A normal EKG and a high-sensitivity troponin at zero and one hour, combined with a low HEART score, give very high confidence that you didn't have a heart attack and that your six-week risk of one is well under 1 percent. That's a strong reassurance, and it's why ERs now discharge many patients home from chest pain workups within a few hours rather than admitting them all. But it doesn't mean you don't have any coronary disease. The ER is good at ruling out an acute event; it's not designed to characterize your long-term risk. Follow up with your primary care doctor or cardiologist for a risk-factor assessment, lipid panel, and discussion of whether further testing (calcium score, stress test, CCTA) is appropriate for you.

I get chest pain with anxiety attacks. Should I still get worked up?

Yes, at least once. Anxiety can cause real chest discomfort, and panic attacks routinely include chest pressure, shortness of breath, palpitations, and a sense of doom. But anxious patients also have heart disease, and missing a cardiac diagnosis in someone with known anxiety is one of the more common patterns I see in second-opinion consultations. A baseline cardiac evaluation with an EKG, lipid panel, and risk assessment is appropriate. If risk factors are present or the pain has features that don't fit panic, additional testing such as a stress test or CCTA is reasonable. Once a baseline cardiac evaluation is reassuring, you and your psychiatrist or therapist can treat the anxiety with confidence rather than wondering each time whether it's something more.

My doctor said it's probably costochondritis. How do I tell?

If pressing firmly on the joint between your rib and your sternum reproduces the exact pain you've been having, costochondritis is likely. The classic exam finding is point tenderness over one or more costochondral or costosternal joints, often with a "clicking" sensation when the rib moves. Cardiac pain is not reproduced by external pressure. Anti-inflammatory medication (ibuprofen, naproxen) and rest usually resolve costochondritis over days to a couple of weeks. If the pain doesn't have point tenderness, doesn't worsen with movement, and doesn't respond to NSAIDs, the diagnosis should be questioned.

I have GERD and chest pain. Is it my reflux or my heart?

Both can present similarly, and many patients have both. Reflux pain is classically a burning sensation, worse after eating or lying down, often with a sour taste in the mouth, and relieved by antacids. Cardiac pain is classically pressure-like, worse with exertion, relieved by rest, and not affected by food. But the overlap is real. A trial of acid suppression often helps, and a complete resolution of symptoms on twice-daily PPI is reasonably specific for GERD. If chest pain persists despite adequate acid suppression, or if you have cardiovascular risk factors, get a cardiac evaluation. The presence of one explanation doesn't preclude the other.

My Apple Watch flagged something. What does that mean?

Apple Watch and similar wearables can detect rhythm abnormalities like atrial fibrillation but are not designed to diagnose chest pain. If you have actual chest discomfort, the wearable data is secondary. Get a real EKG and an evaluation. If your watch flagged a rhythm issue but you have no symptoms, share the tracing with your doctor for context. Wearable EKGs miss things and call out false positives, but a clear AFib alert in a patient who's never had it is worth following up on with a confirmatory EKG and a CHA2DS2-VASc risk assessment for stroke.

I had a heart attack last year and my new chest pain feels different from that one. Should I worry?

Yes. New chest pain in a patient with established coronary disease deserves prompt evaluation, even if it doesn't feel like the previous one. Your previous heart attack tells me your coronary anatomy has plaque, and new symptoms could represent a new lesion, restenosis of a stented segment, or stent thrombosis (rare but serious). Don't reassure yourself that "it doesn't feel like last time." Call your cardiologist the same day, or go to the ER if the pain is severe or accompanied by other symptoms.

I'm a runner and I get chest tightness during long runs. Is that angina?

It might be, and it's worth investigating. Endurance athletes are not immune to coronary disease, and exertional chest tightness in any patient over 40 should be evaluated. The workup typically starts with an EKG and a stress test, often with imaging (stress echo or nuclear). A coronary calcium score is also useful. Some athletes have benign exercise-related chest discomfort from bronchospasm, GERD, or musculoskeletal causes, but the only way to be confident is to test. The cost of being wrong (continuing to push hard with undiagnosed coronary disease) is high.

A Final Note From Me

Chest pain is one of the most common reasons for an ER visit in the United States, accounting for about eight million visits a year. Most of those visits do not turn out to be heart attacks. The system is set up to evaluate chest pain quickly and reassure patients who don't need admission, and the system has gotten very good at it. Coming in for evaluation is not overreacting, even if everything turns out to be fine. The vocabulary I'd encourage patients to keep in mind is that an ER visit for chest pain is a screening test, not a failure of judgment. The screening test sometimes catches a serious problem, and most of the time it doesn't, but the value of the test is in the catching.

If you have a history of coronary disease and your usual chest pain pattern is changing, that's a reason to escalate. If you have a clean cardiac history but a new symptom that's making you worried enough to read articles like this one, get evaluated. The cost of being wrong in the cautious direction is small, often just a few hours and a copay. The cost of being wrong in the dismissive direction can be enormous, including missed STEMIs that present too late for primary PCI to fully restore function.

For prevention, the message is simpler. Most heart attacks happen in patients who had identifiable risk factors that could have been treated more aggressively earlier. Knowing your blood pressure, your lipid panel including Lp(a) and apo B, your A1C, your family history, and your coronary calcium score gives you the information you need to make a real prevention plan with your doctor. The treatments we have for high cholesterol, hypertension, and diabetes have improved dramatically in the last decade, and we have powerful preventive tools available now that didn't exist a few years ago. The work of cardiology is shifting from rescuing patients from heart attacks to preventing them in the first place, and patients who engage early with that effort do dramatically better.

References

1. Gulati, Martha, Phillip D. Levy, Debabrata Mukherjee, et al. "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain." Circulation 144, no. 22 (2021): e368-e454.

2. Backus, Barbra E., A. Jacob Six, Johannes C. Kelder, et al. "A Prospective Validation of the HEART Score for Chest Pain Patients at the Emergency Department." International Journal of Cardiology 168, no. 3 (2013): 2153-2158.

3. Twerenbold, Raphael, Jasper Boeddinghaus, Thomas Nestelberger, et al. "Clinical Use of High-Sensitivity Cardiac Troponin in Patients With Suspected Myocardial Infarction." Journal of the American College of Cardiology 70, no. 8 (2017): 996-1012.

4. Gray, Alasdair J., Carl Roobottom, Jason E. Smith, et al. "Early Computed Tomography Coronary Angiography in Patients With Suspected Acute Coronary Syndrome: Randomised Controlled Trial." Lancet 398, no. 10311 (2021): 1804-1815.

5. Lichtman, Judith H., Erica C. Leifheit-Limson, Eunice Watanabe, et al. "Symptom Recognition and Healthcare Experiences of Young Women With Acute Myocardial Infarction." JAMA Internal Medicine 175, no. 11 (2015): 1863-1871.

6. Tamis-Holland, Jacqueline E., Hani Jneid, Harmony R. Reynolds, et al. "Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association." Circulation 139, no. 18 (2019): e891-e908.

7. Hayes, Sharonne N., Esther S. H. Kim, Jacqueline Saw, et al. "Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association." Circulation 137, no. 19 (2018): e523-e557.

8. Mehta, Laxmi S., Theresa M. Beckie, Holli A. DeVon, et al. "Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association." Circulation 133, no. 9 (2016): 916-947.

9. Mahler, Simon A., Robert F. Riley, Brian C. Hiestand, et al. "The HEART Pathway Randomized Trial: Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge." Circulation: Cardiovascular Quality and Outcomes 8, no. 2 (2015): 195-203.

10. Erbel, Raimund, Victor Aboyans, Catherine Boileau, et al. "2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases." European Heart Journal 35, no. 41 (2014): 2873-2926.

Published on damianrasch.com. The above information was composed by Dr. Damian Rasch, drawing on individual insight and bolstered by digital research and writing assistance. The information is for educational purposes only and does not constitute medical advice.