I'm not a cardiologist, but I work doing cardiac ultrasound (echocardiograms) for a 10 physician cardiology group. What are your risk factors (age, smoking, diabetes, family history of heart disease, elevated cholesterol/triglycerides. etc)? If your ER visit did not reveal an abnormal EKG or "bumped" cardiac enzymes, you most likely did not have a heart attack. That doesn't mean your symptoms weren't real or should be ignored. If your symptoms were severe enough to warrant an ER visit, it would be prudent have some "rule out" testing. The docs I respect most in the group I work for normally will order a nuclear stress test and an echocardiogram for someone with symptoms such as yours. Some docs will order a stress echo, and even though that's the test I do, I don't have absolute faith in them...if you have zero risk factors a stress echo is probably OK, but if it was my family member I would prefer to see them go the separate stress test/echo route. I say "rule out", because if the above tests are normal you most likely do not have coronary disease and they can look for another cause of your symptoms, however no test is 100% reliable. We do have a saying-"denial has killed a lot of people" so it's good to not brush off this episode.