From Our 2010 Archives

Noncardiac Chest Pain May Warrant More Management: Study

SATURDAY, April 24 (HealthDay News) -- People discharged from the hospital with noncardiac (not heart-related) chest pain may require more aggressive cardiovascular risk management than they typically receive, a new study has found.

Noncardiac chest pain can be caused by a number of problems, including panic attack, musculoskeletal pain, gastroesophageal reflux disease (GERD) and esophageal hypersensitivity.

The study included 320 patients who were admitted to the hospital with what was believed to be unstable angina, evaluated and discharged with a diagnosis of noncardiac chest pain. After the initial diagnosis of noncardiac chest pain, 49% of patients were re-evaluated in the emergency department and 42% underwent repeated cardiology evaluations.

Only 15% of the patients had gastrointestinal (GI) consultations. Of those, 38% had esophagogastroduodenoscopy, 4% had manometry (13 tests) and 2% had pH probes (six probes), the study authors reported.

"Patients in this study received few GI consultations and underwent even fewer GI tests. Further study is needed to determine whether patients with noncardiac chest pain would benefit from more frequent GI consultations and more diverse use of GI testing modalities," study co-investigator Dr. Michael Leise, of the Mayo Clinic, said in a news release.

The study also found that patients with noncardiac chest pain didn't have a significantly higher overall rate of death than expected, but a substantial number of cardiac deaths occurred in these patients.

"We speculate that cardiac death in patients with noncardiac chest pain may relate to overlapping risk factors for GERD and coronary artery disease, including obesity, obstructive sleep apnea, diabetes mellitus and smoking," Leise said.

He said until more is known about cardiac death in patients with noncardiac chest pain, doctors should screen these patients for cardiac risk factors, such as high blood pressure, high cholesterol and diabetes, and aggressively manage these conditions.

The study is published in the April issue of Mayo Clinic Proceedings.

-- Robert Preidt

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SOURCE: Mayo Clinic, news release, April 20, 2010