⚠ Emergency: Call 911 / your emergency number if chest pain is:
- Crushing, squeezing or pressure-like pain spreading to your arm, jaw or back
- Accompanied by sweating, nausea, or shortness of breath
- Sudden and severe with no obvious cause
- In someone with known heart disease or risk factors
Blood tests done for chest pain in hospital
| Test | Normal Value | What it checks for |
|---|---|---|
| Troponin I or T (high-sensitivity) | Varies by lab — typically <0.04 ng/mL | Heart muscle damage — the definitive heart attack test |
| CK-MB (Creatine Kinase-MB) | <25 U/L or <5% of total CK | Earlier marker of heart muscle injury |
| D-Dimer | <0.5 mg/L (or <500 ng/mL) | Blood clot — pulmonary embolism (PE) or DVT |
| BNP / NT-proBNP | BNP <100 pg/mL; NT-proBNP <300 pg/mL | Heart failure — stretching of heart chambers |
| CRP | <10 mg/L | Inflammation — pericarditis, infection, ACS risk |
| ECG (not a blood test) | Normal sinus rhythm | ST elevation = heart attack; other changes = ischemia |
Troponin — the heart attack test
ELEVATED Troponin — what it means
Troponin is a protein found inside heart muscle cells. It is released into the blood when heart cells die — as happens in a heart attack (myocardial infarction). Modern high-sensitivity troponin (hs-cTn) tests can detect even tiny amounts of heart damage within 1–3 hours of a heart attack. Levels are checked on arrival and again 1–3 hours later. A rising or falling pattern is just as important as the absolute value. Troponin can also be elevated in other conditions: myocarditis, pulmonary embolism, heart failure, kidney disease and even intense exercise.
Causes of chest pain (non-emergency)
Acid reflux / GERD
Gastroesophageal reflux disease causes a burning sensation in the chest that worsens after meals, when lying down or bending over. It is the most common non-cardiac cause of chest pain. Blood tests are normal. Diagnosis is clinical — and treatment with antacids or PPIs is often diagnostic.
Musculoskeletal pain (costochondritis)
Pain from the ribs, cartilage or chest wall muscles is very common. It is typically sharp, localised, and worsens when you press on the chest or move in certain ways. Blood tests and ECG are normal. Resolves with rest and anti-inflammatory treatment.
Pericarditis
Inflammation of the sac around the heart. Typically causes sharp chest pain that is worse lying flat and better sitting forward. Often follows a viral illness. ECG shows characteristic changes. CRP and ESR are elevated. Treated with NSAIDs and colchicine.
Anxiety and panic attacks
Anxiety can cause real chest tightness, palpitations and shortness of breath that mimic cardiac symptoms. All cardiac tests are normal. Important to rule out heart problems first before attributing symptoms to anxiety.
What does a high D-Dimer mean?
D-Dimer is a fragment produced when a blood clot breaks down. A high D-Dimer doesn't diagnose a clot — it means clotting activity is present somewhere in the body. In chest pain, a high D-Dimer prompts a CT pulmonary angiogram (CTPA) to rule out pulmonary embolism (a blood clot in the lung arteries). D-Dimer is useful when it's NEGATIVE — a normal D-Dimer in a low-risk patient essentially rules out a significant clot. D-Dimer also rises with infection, pregnancy, surgery and cancer, so a positive result alone is not diagnostic.
Heart risk factor blood tests
If chest pain is not immediately threatening, your doctor may also check your cardiovascular risk profile:
| Test | Optimal | Why it matters |
|---|---|---|
| Total Cholesterol | <200 mg/dL | High cholesterol builds arterial plaque |
| LDL Cholesterol | <100 mg/dL | The "bad" cholesterol — main target of statins |
| Fasting Blood Sugar | 70–100 mg/dL | Diabetes doubles cardiovascular risk |
| HbA1c | <5.7% | Average blood sugar over 3 months |
Questions to ask your doctor
- Was my troponin elevated or rising?
- Do I need a stress test or cardiac imaging?
- Could this be acid reflux or a musculoskeletal cause?
- What are my heart disease risk factors?
- Should I be on a statin or aspirin?