Diagnosing a Heart Attack

When you call 911 and describe symptoms of a heart attack, the process of diagnosing the problem begins almost immediately.

Pre-Hospital Care

First, the emergency dispatcher or 911 operator will ask you various questions that will help them pass information along to the responding ambulance crew. Most of the questions will be about symptoms, such as "are you having chest pain," or "did you pass out?"

Once the paramedics or EMTs arrive, the diagnosing process continues. Paramedics will hook the patient up to an electrocardiogram (EKG) machine to check the heart's rhythm. An EKG machine is a series of stickers and wires that attach to the patient's chest. The wires lead to a monitor, which allows paramedics to take a closer look at how the heart is beating. Depending on what the rhythm looks like, as well as the symptoms described by the patient, paramedics may make a field diagnosis of a heart attack. While the final diagnosis rests in the hands of doctors, that field diagnosis is important because it allows paramedics to begin treatment immediately (often while still in the patient's home).

EMTs are not allowed to perform the same advanced procedures as paramedics (such as EKGs, IVs and most medications), but they may also make a field diagnosis in order to pass relevant information on to the hospital.

Emergency Department Care

Once the ambulance arrives at the hospital, the process of diagnosing a heart attack steps up quite a few notches.

* The emergency department will hook up their own EKG machine, to confirm any findings that the paramedics reported.
* X-ray technicians will take a picture of the patient's chest, to make sure there is no fluid in the lungs or the heart.
* You may get an echocardiogram, which uses sound waves to take a picture of the heart.
* You may also get a CAT scan, CT or MRI, which uses computer images to take a picture of the heart.
* Doctors may decide to give you a stress test, which involves walking on a treadmill while doctors watch your heart rate and breathing.

Needles and Pins

So far, most of those tests are non-invasive. But there are several tests that involve invasive procedures as well.

* Blood tests will check levels of cardiac enzymes in your blood. Some enzymes, such as troponin, can predict with near-certainty that you have had a heart attack.
* Depending on what facilities your hospital has, you may be sent to the "Cath Lab" for cardiac catheterization. This involves putting dye into the heart's blood vessels to check for blockages. This process is called an "angiogram."
* Another procedure, called TEE, involves putting a tube down the patient's throat and sending sound waves through it to create a picture of the heart.
* A different kind of stress test is the nuclear stress test. Doctors will inject a radioactive substance into your blood which allows them to take better pictures of the heart muscle.

In the end, doctors will take all this information into account as they decide whether or not you have had a heart attack, what part of your heart it affects, and how they should treat it.