Medical tests
On the basis of the above, a number of tests may be ordered:
An electrocardiogram (ECG)
Chest radiograph or chest x rays are frequently performed
Echocardiography can be useful in patients with known cardiac disease or aortic dissection
CT scanning is used in the diagnosis of aortic dissection
V/Q scintigraphy or CT pulmonary angiogram (when a pulmonary embolism is suspected)
Blood tests:
Troponin I or T (to indicate myocardial damage)
Complete blood count
Electrolytes and renal function (creatinine)
Liver enzymes
Creatine kinase (and CK-MB fraction in many hospitals)
D-dimer (when suspicion for pulmonary embolism is present but low)
serum lipase to exclude acute pancreatitis

Management
Management of chest pain varies with the underlying cause of the pain and the stage of care. Prehospital care
Chest pain is a common symptom encountered by emergency medical services. Aspirin increases survival in people with acute coronary syndrome and it is reasonable for EMS dispatchers to recommend it in people with no recent serious bleeding. Supplemental oxygen was used in the past for most people with chest pain but is not needed unless the oxygen saturations are less than 94% or there are signs of respiratory distress. Entonox is frequently used by EMS personnel in the prehospital environment. However, there is little evidence about its effectiveness. Hospital care
Hospital care of chest pain begins with initial survey of a persons vital signs, airway and breathing, and level of consciousness. This may also include attachment of ECG leads, cardiac monitors, intravenous lines and other medical devices depending on initial evaluation.
An estimated 33% of persons with myocardial infarction in the United States do not present with chest pain, and carry a significantly higher mortality as a result of delayed treatment. Physical examination
Careful medical history and physical examination is essential in separating dangerous from trivial causes of disease, and the management of chest pain may be done on specialized units (termed medical assessment units) to concentrate the investigations. Occasionally, invisible medical signs will direct the diagnosis towards particular causes, such as Levines sign in cardiac ischemia. However, in the case of acute coronary syndrome, a third heart sound, diaphoresis, and hypotension are the most strongly associated physical exam findings. However these signs are limited in their prognostic and diagnostic value. Other physical exam findings suggestive of cardiac chest pain may include hypertension, tachycardia, bradycardia, and new heart murmurs. Chest pain that is reproducible during the physical exam with contact of the chest wall is more indicative of non-cardiac chest pain, but still cannot completely rule out acute coronary syndrome. For this reason, in general, additional tests are required to establish the diagnosis. In the emergency department the typical approach to chest pain involves ruling out the most dangerous causes: heart attack, pulmonary embolism, thoracic aortic dissection, esophageal rupture, tension pneumothorax, and cardiac tamponade. By elimination or confirmation of the most serious causes, a diagnosis of the origin of the pain may be made. Often, no definite cause will be found and reassurance is then provided.