In distinguishing chest pain caused by heart disease from GERD, a doctor will conduct an anamnesis to inquire about the patient's medical history and perform a physical examination.

To diagnose heart disease, the following examinations are necessary:

1. Electrocardiogram (ECG) is a recording of the heart’s electrical activity. This test can assess ischemia (reduced blood flow to the heart muscle) due to coronary artery disease.
2. Echocardiogram is a heart examination using ultrasound.
3. Exercise Stress Test (Treadmill Test) is a heart examination that involves monitoring the heart and recording its activity while walking or running on a treadmill.
4. Troponin I is a blood test used to detect heart muscle damage.
5. Cardiac CT is a CT scan of the heart that can detect abnormalities in the heart structure, such as coronary artery blockages, vascular anomalies, and other conditions, allowing early detection of abnormalities and accurate diagnosis.

For individuals who frequently experience chest pain and show signs of ischemia during non-invasive tests such as ECG, treadmill test, or cardiac CT, the doctor may recommend cardiac catheterization. This medical procedure involves inserting a thin, long, and flexible tube into the heart's blood vessels, allowing for the determination of the cause of chest pain and immediate assessment of further treatment or action.

To diagnose GERD, the following tests are necessary:

1. PPI Test Therapy involves administering double-dose PPIs for 1-2 weeks before performing an endoscopy. If the symptoms improve during therapy and worsen when the therapy is stopped, the diagnosis can be confirmed.
2. Endoscopy is an internal examination using a small camera tube.
3. Esophageal pH Monitoring is a test where a tube is inserted through the nose down to the esophagus. This test measures the acidity level in the esophagus.

Author: Dr. Dian Rahma Dewi (Medical Service Doctor, Surabaya Adityawarman Branch)