If you’ve ever accompanied someone to the emergency room with chest pain — or experienced it yourself — things move fast, and for good reason.

The first 10 minutes can help emergency clinicians identify a heart attack or other life-threatening condition and determine how rapidly treatment is needed.

For most people who go to the emergency room with chest pain, the cause turns out to be something other than a heart attack. But a heart attack can’t be ruled out without testing, so chest pain is treated as a priority emergency, and the ER team moves quickly.

“Because chest pain can signal a life-threatening problem, we prioritize those patients the moment they arrive, even when the department is busy,” said Dr. Sarah Orlousky, chief of staff and associate medical director of emergency services at Novant Health Ballantyne Medical Center in Charlotte, which holds a Chest Pain Center Accreditation from the American College of Cardiology. “That’s because minutes mean heart muscles are either saved or lost.”

ERs are often busy places. But Orlousky said to not hesitate to call 911 or go to the nearest emergency room if you experience chest pain. That urgency applies even if the pain feels different, or less severe, than what you’d expect a heart attack to feel like.

Here, Orlousky explained how her clinical team navigates those visits — and what patients with chest pain can expect.

What could chest pain mean?

The key emergencies we’re looking for when patients arrive are heart attack, blood clots in the lungs, an aortic dissection (a tear in the body’s main artery) or a collapsed lung. Anxiety, stress, acid reflux and a muscle strain can also cause chest pain. So, the first thing we do is evaluate for the big emergencies.

Walk us through those next few critical minutes.

Patients who call an ambulance for chest pain typically have an electrocardiogram (EKG) performed by the paramedics. If it shows a big heart attack known as a STEMI, the patient is taken to a hospital with a cardiac catheterization lab.

Patients who arrive on their own enter triage, where chest pain is flagged for immediate attention and treatment. They have the attention of a triage nurse and typically a paramedic and/or a certified nurse assistant.

The team starts with performing an EKG, and if the EKG does not show a STEMI, we continue evaluating for other causes of chest pain. The team draws blood work and orders imaging; depending on the patient's chest pain, that could be an X-ray, a CT scan or an ultrasound. If there’s no heart attack and vital signs are stable, we evaluate the chest pain for other causes.

What is an EKG looking for?

An EKG is a recording of the heart’s electrical activity. We’re looking for signs that a part of the heart isn’t getting enough blood flow, that a fully blocked artery is causing a major heart attack, or that the heart is beating in a dangerous rhythm.

A normal first EKG does not rule out a heart attack. It’s a snapshot of a few seconds, and some heart attacks — especially early or partial ones — don’t show up right away, so an EKG may need to be repeated if symptoms change or continue. We pair the EKG with blood tests and a careful history and exam.

How quickly does the team aim to perform an EKG?

The American College of Cardiology and the American Heart Association recommend that an EKG be performed and interpreted within 10 minutes of arrival for patients with chest pain, and that’s our goal.

What can blood work reveal?

When we draw blood on patients with chest pain, we order a sensitive blood test for troponin, a protein released when heart muscle is injured. We also run routine labs that check blood counts, how the blood clots, electrolytes, and kidney function. Those results can also help us evaluate and treat a heart attack and other causes of chest pain. Results for the blood tests typically come back in about an hour.

Depending on the patient’s symptoms, timing and risk, we may repeat the troponin test to see whether the number is rising, falling or staying flat over the next few hours. That trend can be very important in determining the cause of the chest pain and in ruling out a heart attack.

What should patients or family members tell the ER team right away?

It’s most helpful for us to know when the pain started, what it feels like and whether it’s still there. Any other symptoms like nausea, sweating, shortness of breath, dizziness or jaw or back pain can be signs of a heart attack. It’s also helpful for us to know current medications, as well as heart history, including prior heart attacks, stents or surgery.

What happens if tests show something is wrong?

Treatment depends on what the tests show. It can range from an emergency procedure to open a blocked artery, to admission or observation for further testing, to going home with medication and a follow-up with a cardiologist. Our goal is to get each patient on the right path as quickly as possible.

What's the most important thing to remember if you experience chest pain?

Don’t wait. Call 911 rather than drive yourself to the emergency department. Paramedics can start care before you arrive and often call us ahead to report on their findings.