Diagnosis and treatment tend to occur at the same time in patients who are experiencing chest pain. If there is concern that heart muscle is at risk, delays need to be minimized so that blood supply to that muscle can be restored.

Physical examination
While the diagnosis is based on history, the physical exam can give some clues.

• Blood pressure and pulse rate normal
• The lungs sound clear
• Findings of an infection (pneumonia) or fluid (edema)?
• Bruits (noises produced by narrowed blood vessels that are heard with a stethoscope) present when listening to the neck, abdomen, or groin
• Tenderness in the abdomen that would suggest the chest pain is due to gallbladder, pancreas, or ulcer disease
  

EKGs, blood tests, and chest X-ray are other tests that are likely to be performed to assist with the diagnosis.

Electrocardiogram
The Electrocardiogram (ECG or EKG) will help direct what happens acutely in the ER. The ECG measures electrical activity and conduction in heart muscle. In a heart attack in which the full thickness of the heart muscle is involved, the ECG shows characteristic changes that establish the diagnosis of a myocardial infarction. Some heart attacks only involve small parts of the heart muscle; in these cases, the ECG can look relatively normal.

Blood tests
Blood testing may be required to further look for heart damage. When heart muscle becomes irritated it may leak chemicals that can be measured in the blood. Levels of the cardiac enzymes myoglobin, CPK, and troponin are often measured, alone or in combination, to assess whether heart muscle damage has occurred. Unfortunately, it takes time for these chemicals to accumulate in the blood stream after the heart muscle has been insulted. Blood samples need to be drawn at the appropriate time so that the results can be usefully interpreted. For example, the recommendation for the troponin blood test is to draw a first sample at the time the patient arrives in the ER, and then a second sample 6-12 hours later. Usually it requires two negative samples to confirm that no heart muscle damage has occurred. (Please note that under special circumstances, one sample may be sufficient.)

Chest X-ray
A chest X-ray may be taken to look for a variety of findings including the shape of the heart, the width of the aorta, and the clarity of the lung fields.

If a heart attack has been proven not to have occurred, that is a heart attack has been "ruled out," further evaluation of the heart may be undertaken using stress tests, echocardiography, CT scans, or heart catheterization. The decision as to which test(s) to use, needs to be individualized to the patient and his or her specific situation.

http://www.emedicinehealth.com/heart_attack/page5_em.htm

TMT Stress test
It is common to find heart patients who have normal ECG. One must remember that the ECGs are taken at rest when the heart is beating at its lowest rate. Even with 90% blocks the patients can have a normal ECG.

This is the condition where we need a TMT test. The patients are to gradually increase their heart rate, thus increasing the blood requirement of the heart muscles. Simultaneously ECG records are taken. If there is a blockage of approximately more than 70% ECG shows changes, suggestive of Angina.

Echo Test
An echocardiogram (often called "echo") is a graphic outline of the heart's movement. During this test, high-frequency sound waves, called ultrasound, provide pictures of the heart's valves and chambers. This allows the technician, called a sonographer, to evaluate the pumping action of the heart. Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart's.

http://www.medicinenet.com/echocardiogram/article.htm

Treatments

How Is a Heart Attack Treated?
Early treatment can prevent or limit damage to the heart muscle. Acting fast, at the first symptoms of heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital.

Certain treatments are usually started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include:

• Oxygen
  
• Aspirin to prevent further blood clotting
  
• Nitroglycerin, to reduce the workload on the heart and improve blood flow through the coronary arteries
  
• Treatment for chest pain
  

Once the diagnosis of heart attack is confirmed or strongly suspected, treatments to try to restore blood flow to the heart are started as soon as possible. Treatments include medicines and medical procedures.

Medicines
A number of different kinds of medicines may be used to treat heart attack. They include the following.

• Antiplatelet Medicines
  
• Anticoagulants
  
• Angiotensin-Converting Enzyme (ACE) Inhibitors
  
• Beta Blockers
  
• Thrombolytic Medicines

Medical Procedures
If medicines can’t stop a heart attack, medical procedures—surgical or nonsurgical—may be used. These procedures include the following.

Angioplasty
This nonsurgical procedure can be used to open coronary arteries that are blocked by a blood clot. During angioplasty, a catheter (a thin, flexible tube) with a balloon on the end is threaded through a blood vessel to the blocked coronary artery. Then, the balloon is inflated to push the plaque against the wall of the artery. This widens the inside of the artery, restoring blood flow.

During angioplasty, a small mesh tube called a stent may be put in the artery to help keep it open. Some stents are coated with medicines that help prevent the artery from becoming blocked again.

Coronary Artery Bypass Grafting
Coronary artery bypass grafting is a surgery in which arteries or veins are taken from other areas of your body and sewn in place to bypass (that is, go around) blocked coronary arteries. This provides a new route for blood flow to the heart muscle.

Treatment After You Leave the Hospital
Most people spend several days in the hospital after a heart attack. When you leave the hospital, treatment doesn’t stop. At home, your treatment may include daily medicines and cardiac rehabilitation (rehab). Your doctor may recommend lifestyle changes, including quitting smoking, losing weight, changing your diet, and increasing your physical activity, to lower your chances of having another heart attack.

Cardiac Rehabilitation
Your doctor may prescribe cardiac rehab to help you recover from a heart attack and to help prevent another heart attack. Almost everyone who has had a heart attack can benefit from rehab. The heart is a muscle, and the right exercise will strengthen it.

But cardiac rehab isn’t only about exercise. It also includes education, counseling, and learning about reducing your risk factors. Rehab will help you learn the best way to take care of yourself after having a heart attack and how to prevent having another one.

The cardiac rehab team may include doctors (your family doctor, a cardiologist, and/or a surgeon), nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.

http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_Treatments.html