Chest Pain: Heart, Esophagus, or ?
NETHERLANDS--Patients with chest pain that appears to be coming from the heart (angina-like) are commonly evaluated by heart specialists (cardiologists). It is well known, however, that there are many causes of chest pain that mimic heart pains but do not come from the heart. These non-cardiac causes include spasm and heartburn from the esophagus (gastroesophageal reflux disease), gallbladder attack, inflammation of the chest wall, and, rarely, tear of the aorta.
In a study (1997) published in the medical journal, CHEST, Jan H. Voskuil, M.D. and associates reported their data of patients who were newly-referred to the cardiologist for evaluation of chest pain that appeared to be coming from the heart. The study was designed to determine the prevalence of abnormalities of the tube that carries food from the mouth to the stomach (esophagus) in these patients.
The data of Dr. Voskuil's study suggested that over one third of the patients with chest pain who were referred to a cardiologist were actually experiencing symptoms caused by gastroesophageal reflux disease (GERD). Furthermore, the cause of the chest pain was frequently not found with routine studies of the heart or esophagus. A small percentage of patients had both heart and esophagus causes for their chest pain.
Interestingly, the interpretation of the patients' description of their symptoms (history) by subspecialty physicians was not found to be particularly accurate in predicting the origin of their chest pain.
The authors of the study recommend early evaluation of the esophagus in patients with chest pain who have had normal tests of the heart (EKGs, heart enzyme blood tests, and exercise stress tests).
In a related study from the University of Iowa, published simultaneously in the Annals of Internal Medicine, Satish S.C. Rao, M.D. and associates found that the esophagus of patients with chest pain and normal routine evaluations of the heart and esophagus was unusually sensitive to stretching. In an accompanying editorial, Raj K. Goyal, M.D. points out that further study in this area may lead to new treatments directed toward pain sensation of internal organs.