With 5 million people each year rushing into emergency rooms complaining of symptoms such as these, doctors face a difficult task: assessing whether or not it is a heart attack -- the leading cause of death in the United States -- or something much more benign, like indigestion or angina. Often the medical history, physical examination and electrocardiogram do not provide conclusive information, says Dr. Robert Roberts, chief of cardiology at Baylor College of Medicine. This can delay treatment for those who need it most; it can also fill up intensive care units with people who may have just inhaled their spaghetti dinner a little too quickly.

"The nature of chest pain is virtually the same, and both are relieved by nitroglycerin," he explains. In fact, according to Roberts, only 10 percent of all the people who think they're having a heart attack actually are.

"It's not an easy thing to diagnose," concedes Elaine Josephson, a doctor at the ER at St. Luke's Hospital in New York and spokeswoman for the American College of Emergency Physicians. "Sometimes it's clear cut, when you evaluate the patient, look at the EKG, and see, 'Yup, this person is having a heart attack.' Other times you're not sure, the pain comes and goes and you don't have the luxury of an old EKG to compare it to."

For most of Roberts' professional life, he has been trying to develop ways to speed up diagnosis for a disease for which every moment matters. In 1974 he developed an important heart test that many hospitals still currently use. Then, eight years ago, Roberts created a new test -- a blood test that can usually tell within an hour if the person is having a heart attack or not. The problem is that most hospitals are still not using it.

In this week's Circulation, the journal of the American Heart Association, Roberts and his team published the results of the first comprehensive study on this new test. Doctors at the Baylor College of Medicine and the University of Texas Medical School tested patients at four hospitals in Houston and then had the results compiled by an outside source. Neither the lab technicians drawing the blood nor the doctors treating the patients knew about results, treating the patients as they normally would. Roberts estimates that the test, if widely used, could save hospitals billions of dollars, and save lives. Salon Health & Body interviewed Roberts by phone from his office in Houston about why this test has not become a fixture in emergency departments across the country, the dangerous crowding in intensive care units and the psychological effects of thinking you're having a heart attack.

What happens when a person walks into an emergency room and complains about chest pains?

There are several issues that we face. First of all, is this a heart attack that must be taken care of now? Secondly, is this pain of the heart (angina), which is not associated with actual damage to the heart? And thirdly, where do we go from here? We can't obviously admit everybody to the hospital.

It is almost impossible to tell by just looking at their medical history and doing a physical examination. And the electrocardiogram, which is routinely administered, will only identify about 40 percent of all heart attacks.

Why is time so important with heart attacks?

When a clot has formed to block off the blood supply to an artery, that part of the heart looses the blood, or at least most of it. If it loses it for more than 15 minutes, it will die. But if you restore blood flow in less time than that, it will essentially recover. Death marches from the inside of the heart to the outside, and it marches over a period of four to six hours. And that's why if you restore blood flow within six hours -- by using blood clotters or angioplasty -- you still will decrease the amount of damage and the death rate. At one hour, it's a 1 percent death rate, and at six, it's a 10 percent, after that it levels out at about 15 percent.

What was the old test like?

For decades, we used an approach called creatine-kinase MB (CK-MB), which took 10 to 12 hours to find out if the person was having a heart attack. CK-MB is an enzyme that's released from the heart in increased amounts after the beginning of an attack. We measure it. But since it takes so long to get the results, a lot of people get admitted to hospitals -- to wait out that interval -- only to find out nine hours later that's it's negative, and then they are sent home. Our study estimates that about $12 billion a year is spent unnecessarily admitting people who didn't need to be admitted. A lot of that money can be eliminated if you use CK-MB subform [the new test].

Next page | Will the new test do more than make the HMO bean counters happy?