Diagnostic Workup for Chest Pain and Palpitations
Chest pain ranges from harmless musculoskeletal soreness to life-threatening cardiac events. Here’s the diagnostic ladder our cardiology-trained radiologists recommend.
Starting point: ECG + clinical assessment
A resting ECG is the first test in nearly every chest-pain workup — fast, cheap (~₹350), and rules out acute ischaemia or arrhythmia in minutes.
2D Echo: structural assessment
2D Echo evaluates heart muscle function, valve disease, chamber sizes, and ejection fraction. Recommended if there’s any suspicion of structural heart disease, prior MI, or persistent palpitations.
TMT, Holter, or stress imaging — when?
TMT (Treadmill Test) for exertional chest pain. 24/48-hour Holter monitor for palpitations that come and go. Stress Echo or Cardiac MRI when TMT is inconclusive. Coronary CT angiography when concern is anatomical coronary disease.
Frequently asked questions
Difference between TMT and 2D Echo?
TMT is a stress test on a treadmill — looks for exercise-induced ECG changes. 2D Echo is a resting ultrasound of the heart — looks at structure and function. They answer different questions and are often done together.
