World Heart Day 2025: How Accurate Is an ECG in Detecting Heart-Related Chest Pain?

Today, on World Heart Day 2025, understanding the early signs of a heart attack has never been more critical. Chest pain is one of the most common reasons people rush to hospitals, but not all discomfort signals a cardiac problem. According to Dr. Binay Kumar, Senior Consultant – Interventional Cardiology & Electrophysiology at Yatharth Hospitals, timely and accurate testing is essential to distinguish heart-related issues from other causes.Doctors rely on a combination of clinical examination, rapid tests, and advanced imaging to make these assessments. A detailed medical history and physical examination can provide initial clues about the likelihood of a cardiac event. Alongside this, an electrocardiogram (ECG) is typically performed immediately. The ECG records the heart’s electrical activity, helping detect patterns indicative of a heart attack or restricted blood flow.Blood tests for cardiac biomarkers, especially troponin, are also vital in confirming heart muscle injury. Chest X-rays may be conducted to exclude other causes of pain and to examine heart size or potential lung complications. Dr. Kumar said “While these initial tests are crucial, they have their limitations, and further investigation is sometimes necessary.”Which Tests Should Be Done for Chest Pain?Electrocardiogram (ECG): First-line test to detect irregular heart rhythms or evidence of a heart attack.Blood tests: Check for cardiac enzymes like troponin, which rise during a heart attack.2D Echocardiography: Assesses the pumping function and overall structure of the heart.Treadmill stress test: Monitors how the heart responds under physical exertion.Angiography: A detailed imaging test to confirm blockages in coronary arteries, often used in high-risk cases.Accuracy of ECG in Chest PainWhile ECGs are a vital diagnostic tool, they have limitations. Dr. Binay Kumar noted that a normal ECG does not necessarily mean the heart is healthy. The sensitivity of ECGs for detecting coronary artery disease can be relatively low, and in some cases, significant blockages may not be immediately apparent. On the other hand, abnormal readings are often more specific for heart events, but even then, doctors must interpret results in the context of symptoms, risk factors, and patient history. Because of these limitations, ECGs are often repeated or supplemented with other tests if clinical suspicion remains high.When to Move Beyond ECGNot every case of chest pain can be explained by ECG and blood tests alone. Persistent, worsening, or recurring pain may prompt doctors to explore further. Stress tests, for example, monitor how the heart responds to exercise or medication, helping identify areas with reduced blood flow. Echocardiograms, which use ultrasound to assess heart function, are especially useful when ECG results are inconclusive. “These tests allow us to detect subtle issues that might otherwise go unnoticed,” Dr. Binay Kumar explained, highlighting the importance of combining multiple diagnostic tools for a more accurate assessment.Advanced Tests for Identifying Heart BlockagesFor high-risk patients or when non-invasive tests indicate significant concerns, coronary angiography remains the gold standard. This invasive procedure provides a direct view of blockages, guiding treatments such as angioplasty or bypass surgery. CT coronary angiography offers a non-invasive alternative, producing detailed 3D images of coronary arteries and allowing doctors to visualize potential problems without surgery. Stress echocardiography, nuclear perfusion imaging, and cardiac MRI can further detect areas of reduced blood flow and evaluate heart muscle health.Dr. Binay told us, “A stepwise approach is essential. ECG and troponin tests serve as rapid triage tools, while advanced imaging should be reserved for patients whose risk or symptoms warrant more detailed evaluation. By following these strategies, hospitals can ensure timely diagnosis, appropriate treatment, and better outcomes for patients presenting with chest pain.”He further recommends:Use ECG and blood troponin tests for initial triage.Escalate to stress testing or imaging for persistent or unexplained symptoms.Reserve coronary angiography for high-risk patients or confirmed abnormalities.Consider non-invasive imaging like CT angiography for intermediate-risk patients needing detailed assessment.

World Heart Day 2025: How Accurate Is an ECG in Detecting Heart-Related Chest Pain?

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