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It can be hard to tell if chest pain is unstable angina. But this condition is a medical emergency. So if you have symptoms that might mean unstable angina, you or someone with you should dial 911 right away.

When you reach the emergency room of your hospital, the doctor will ask you some questions about the pain and discomfort in your chest and your health. He or she will also examine you and do some tests.

It isn't always easy to diagnose unstable angina. That's because there are so many other causes of chest pain. Here are some things your doctor might do to help tell if you have angina.

Your doctor may ask you these questions.

• How would you describe the discomfort or pain you feel?
• What brings on this feeling?
• How long does it last and what makes it go away?
• Is there a regular pattern to it, and can you tell when it will happen?
• How long have you had it, and is it getting any worse?
• Do you smoke?
• Does heart disease run in your family?
• Do you have high blood pressure?
• Do you have high cholesterol?
• Do you have diabetes?
• What kind of work do you do?
• What kinds of foods do you eat?

If there is any doubt about what is causing your discomfort or pain, your doctor will ask you more questions. For more, see Other causes of chest pain.

Your doctor will give you a physical examination to learn more about what could be causing your symptoms. Here are some things he or she may do.

• Measure your blood pressure and feel your pulse. Your pulse tells your doctor how fast your heart is beating and if the beat is regular.
• Listen to your heart, especially for any extra noises called murmurs. These may be a sign of a problem with your heart valves. Sometimes valve problems can cause angina.
• Listen to the blood flowing though the arteries in your neck to see if there are any extra noises. These noises may mean that your arteries are narrowed.
• Look for bumps under your skin that are a sign of high cholesterol. For example, you may have firm white bumps around your eyes. High cholesterol can put you at risk for narrowing of your arteries.
• Listen to your lungs for any extra noises while you breathe. These could be caused by lung disease or by heart failure. You can get heart failure if your heart is damaged, so it doesn't pump well.
• Measure your height and weight to figure out if you are overweight. If you are overweight, this puts an extra strain on your heart.
• Check for less common causes of angina. For example, your doctor will look for signs of anemia and an overactive thyroid gland. Both can cause angina. For more, see Other causes of angina.
• Check for causes of chest pain that don't have anything to do with your heart. For more, see Other causes of chest pain.

If you do have angina, your doctor will also try to find out what type you have. We have looked at treatments for the type called unstable angina. But there are two other types. For more, see Other types of angina.

The most common tests for unstable angina are listed below.^{1 2} You are likely to have an electrocardiogram (ECG for short) and a troponin test soon after you reach the hospital. You may also have some of the other tests as well, either then or later on. It depends on what your doctor thinks is wrong with you.

• An electrocardiogram (ECG). The first test your doctor will suggest is an electrocardiogram, or ECG for short.^{1 2} The ECG shows the electrical activity in your heart as a line on a graph. This test helps your doctor tell if your heart is beating properly and if you have certain heart problems. See Electrocardiogram to learn more.
• Blood tests. Your doctor will also suggest some blood tests. These include a test for a protein called troponin. This will help your doctor decide whether you have unstable angina or have had a heart attack. See Troponin test to learn more. Other tests can help tell if you have anemia, diabetes or high cholesterol. If your doctor thinks you might have an overactive thyroid gland, you'll need a blood test for that, too.
• An echocardiogram. This test uses sound waves to make a picture of your heart. It's sometimes called an "echo" for short. The picture shows how blood flows through your heart and if your heart is pumping properly, among other things. See Echocardiogram to learn more.
• Coronary angiography. This test uses a dye to make your coronary arteries show up on an X-ray. It can show blockages. See Coronary angiography to learn more.
• A trial of treatment. Your doctor may give you a treatment for angina to see if it takes away your discomfort or pain. The treatment is called nitroglycerin.
• An X-ray. If your doctor thinks you might have lung disease or heart failure rather than unstable angina, you will need an X-ray of your chest.
• A stress test. When your symptoms have settled down and your doctor is sure that you are not in danger, he or she may advise you to have a stress test, or to come back to the hospital to have it at another time. Stress tests make your heart work harder. They can uncover problems that don't show up while you're resting. See Stress test to learn more.

Some people with unstable angina are at greater risk than others of having a heart attack or other serious heart problems. By figuring out your risk, your doctor can decide which treatment is best for you. For more, see Unstable angina: figuring out your risk.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.