Because heart disease is the leading cause of death in the united states,1 it is important to diagnose a cardiac etiology in patients presenting with acute chest pain. Table 1 cardiology causes of chest pain 3 assessment. New therapies for noncardiac chest pain springerlink. Describe the detailed evaluation of a pediatric patient who has chest pain. Medicines may be given to treat the cause of your chest pain. Diagnosing the cause of chest pain american family physician. Chest pain and heart pain are mistaken to be same by many. Differentiating on a clinical basis only between cardiac angina and nccp has been shown to be a very difficult task. If the initial evaluation indicates that a cardiac cause of acs is less likely, other noncardiac causes of chest pain should be considered. Chest pain of cardiac origin is usually associated with coronary artery disease.
Assessment of chest pain differential diagnosis of symptoms. If gerd is an unlikely cause of patients symptoms, an esophageal motor disorder should be excluded. Difference between chest pain and heart pain compare the. A cardiac cause may be inferred if the presenting symptomssuch as lightheadedness, palpitations, chest pain, and syncopeindicate mi. Noncardiac chest pain nccp is recurrent angina pectorislike pain. The evaluation and management of the patient with chest pain syndrome is a diagnostic challenge to all who practice emergency medicine. The pain does not change with respiration or position. Apr 07, 20 repetative pain in the chest which cant be credited to disease of the heart. Randomised trials have shown the effectiveness of specialist psychological treatment with those who have persistent symptoms, but such treatment is not always acceptable to patients and may not be feasible in. The increasing frequency of chest pain, due to the lengthening of the life span, and the importance of differentiating between chest pain of cardiac and non cardiac origin cannot be overemphasized.
Noncardiac chest pain fulltext visceral medicine 2018, vol. Chest pain syndrome is inclusive of symptoms that may be caused by acute myocardial ischemia and includes such diverse complaints as chest pain, chest pressure. The end portions of the text were exerpted from chest pain. Major causes of acute chest pain include cardiac, gastroesophageal, musculoskeletal, and pulmonary condi. Nov 15, 2005 chest pain is the chief complaint in about 1 to 2 percent of outpatient visits,1 and although the cause is often noncardiac, heart disease remains the leading cause of death in the united states. Because of the difficulty in differentiating noncardiac chest pain from myocardial infarction or ischemia, and because of the malpractice risk of discharging a patient with an undiagnosed dangerous cardiac condition, patients are often admitted to the hospital.
Noncardiac chest pain is the medical terminology used for chest pains which are not related to any specific heart condition, but are quite similar to pains experienced due to pain from a cardiac condition. Dobutamine stress teleechocardiography for evaluation of. Noncardiac chest pain is usually felt underneath the sternum and is squeezing and pressurelike in quality. Definition noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause. New research suggests a novel approach to treating non cardiac chest. Noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause. There is a dichotomy in the assessment of patients with possible acs. Cardiac and noncardiac chest pain jama jama network. Learning objectives noncardiac chest pain and gerd when and why refer to a gastroenterologist treatment approaches. The increasing frequency of chest pain, due to the lengthening of the life span, and the importance of differentiating between chest pain of cardiac and noncardiac origin cannot be overemphasized. The typical patient with the first bout of chest pain immediately fears the onset of cardiac pathology. In children and adolescents, chest pain is a commonly encountered problem.
Oct 21, 2014 chest pain doesnt necessarily come from the heart. Noncardiac chest pain nccp is very common in the general population. Angina pectoris however has some characteristics that can help to differentiate between other causes of chest pain. Background noncardiac chest pain assessed by cardiologists in their outpatient clinics or by coronary angiography usually has a poor symptomatic functional and psychological outcome. Pdf on jan 1, 2004, bernard karnath and others published chest pain. While chest pain can be a bona fide symptom of coronary artery disease. In contrast, noncardiac pain can begin suddenly and feel worst in the. While incidence varies according to setting, country and inclusion criteria 24, there is a similar range of different diseases that can cause chest pain in a primary care setting5,6. First, early and accurate identification of patients with stsegmentelevation myocardial infarction stemi enables provision of emergency reperfusion therapy, which has a major impact on outcome, while accurate identification of patients with other types of acs nonstsegment. Role of soluble and plateletbound pselectin in discriminating cardiac from noncardiac chest pain at presentation in the emergency department paul a. The approach to patients with possible cardiac chest pain. Outpatient diagnosis of acute chest pain in adults american. It typically stems from problems with the esophagus, like gastroesophageal reflux illness or spasms of the esophagus, or by musculoskeletal illnesses or dysfunctions, especially fibromyositis.
Patients with nccp may report squeezing or burning substernal chest pain, which may radiate to the back, neck, arms and jaws, and is indistinguishable from cardiac related. An estimated 200,000 americans each year experience noncardiac chest pain. Differentiating cardiac from noncardiac causes find, read and cite all the research you need on researchgate. The pain, which may be relieved by glyceryl trinitrate gtn, can radiate to the arms or neck although it can be very difficult to separate nccp from true cardiac pain. Evaluation of patients with chest pain and normal coronary.
Angina pectoris is usually is brief and gradual in onset and offset, with the intensity increasing and decreasing over several minutes. Noncardiac chest pain is a prevalent disorder resulting in high healthcare utilization and significant work absenteeism. Noncardiac causes are common, but it is important not to overlook. Differentiating between cardiac chest pain and noncardiac chest pain can be a difficult task and one that paramedics must make on a daily basis. Although some patients with chest pain have heart failure, this is. Lenfant c 2010 chest pain of cardiac and noncardiac origin.
Chest pain that is reproducible during the physical exam with contact of the chest wall is more indicative of non cardiac chest pain, but still cannot completely rule out acute coronary syndrome. Abnormal endothelial function has received increased attention of late, since at a largevessel and. Acute coronary syndrome acs, encompassing unstable angina, stelevation myocardial infarction, and nonstelevation myocardial infarction, may not be the most common aetiology in patients presenting with chest. Nursing assessment of the causes of chest pain british. However, noncardiac pain is extremely prevalent and at times just as concerning if the entity is missed. Because heart disease is the leading cause of death in the united states, 1 it is important to diagnose a cardiac etiology in patients presenting with acute chest pain. Chest pain in children and adolescents american academy of. Noncardiac chest pain journal of neurogastroenterology. After excluding a cardiac cause, potent antireflux therapy should be administered to patients with noncardiac chest pain since gastroesophageal reflux disease gerd is the most common underlying mechanism of this disorder. Describing chest pain chest pain caused by angina or a heart attack may be similar to or different from chest pain caused by other conditions. Chest pain is the presenting complaint in over 6 million emergency department visits each year.
Pain due to insufficient blood flow to the heart is also. The initial goal in patients presenting with chest pain is to determine if the. Chest pain is pain or discomfort in the chest, typically the front of the chest. An estimated 200,000 americans each year experience non cardiac chest pain. Novel approach for treating noncardiac chest pain suggested. Noncardiac chest pain journal of neurogastroenterology and. Background non cardiac chest pain assessed by cardiologists in their outpatient clinics or by coronary angiography usually has a poor symptomatic functional and psychological outcome. Randomised trials have shown the effectiveness of specialist psychological treatment with those who have persistent symptoms, but such treatment is not always acceptable to patients and may not be. Approach to undifferentiated chest pain in the emergency. Depending upon the cause, chest pain can have varying qualities sharp, dull, burning, can be located in one or several areas middle of the chest, upper or left chest, back, arms, jaw, neck, or the. Because chest pain can be a sign of a heart attack, if the pain is due to. Since chest pain is common in persons over 50 years of age, it is important to differentiate between that caused by coronary artery disease and that due to othe.
Chest pain is a common complaint seen by emergency physicians, and most concerning are cardiac etiologies of the pain. Patients with chest pain and a negative initial cardiac evaluation should. In addition, noncardiac causes of chest pain may be serious. Excerpt the increasing frequency of chest pain, due to the lengthening of the life span, and the importance of differentiating between chest pain of cardiac and noncardiac origin cannot be. Differentiating acute coronary syndrome acs from other, noncardiac causes of chest pain is imperative in emergency practice. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Evaluation and management of patients with noncardiac.
Gerd is the most common cause of noncardiac chest pain or discomfort, accounting for about 50% of all cases. Noncardiac chest pain nccp is defined as the presence of pain resembling angina in the absence of evidence of any coronary artery disease 1, 2. Hussain md prepared by high desert state prison medical education department, july 2009. Mcneill mm 2005 pericardial, myocardial and endocardial disease. Assessment of chest pain differential diagnosis of. Fortyone patients with chest pain and normal coronary arteriograms had platelet hyperaggregability in response to adenosine diphosphate or epinephrine stimulus, 71 but the clinical relevance of this in vitro observation requires confirmation. It can be divided into heartrelated and nonheartrelated pain. Enumerate the most common causes of chest pain in pediatric patients. Screen and identify patients who require a referral to a pediatric cardiologist or other specialist. Differentiate cardiac chest pain from that of noncardiac cause. Most important, you and the patient must understand each other.
Major causes of acute chest pain include cardiac, gastroesophageal, musculoskeletal, and pulmonary conditions. You may be given medicines to decrease pain, relieve anxiety, decrease acid reflux, or relax muscles in your esophagus. The truth is a paramedic in the field cant with complete accuracy. Chest pain in children and adolescents american academy. Patients with nccp may report squeezing or burning substernal chest pain, which may radiate to the back, neck, arms and jaws, and is indistinguishable from cardiac related chest pain. Despite much concern that underlying cardiac pathology is at play, the percentage of pain attributed to a cardiac etiology is low with an incidence of less than 5%. Assessment and differentiation of the various chest pain presentations can be. Despite popular belief left sided chest pain is unlikely to indicate a cardiac origin. Noncardiac chest pain is a common encounter in the general practice but occasionally management can be tricky and therefore a shared plan with a.
Differentiating cardiac from noncardiac causes find, read and cite all the research. For this reason, in general, additional tests are required to establish the diagnosis. Associated symptoms may include pain in the shoulder, arm, upper abdomen or jaw or nausea, sweating or shortness of breath. Chest pain may be caused by either benign or lifethreatening aetiologies and is usually divided into cardiac and noncardiac causes. Every chest pain is not heart pain cardiac pain and heart pain may not be present as chest pain. The criteria usually employed in differentiating between angina and non cardiac chest pain are. Chest pain has an extensive differential diagnosis. How can a paramedic differentiate between cardiac chest pain and noncardiac chest pain. It is situated inside the chest cage towards the left side. Aug 10, 2011 the end portions of the text were exerpted from chest pain. It may be described as sharp, dull, pressure, heaviness or squeezing. Chest pain may be caused by either benign or lifethreatening aetiologies and is usually divided into cardiac and non cardiac causes. Lee yeong yeh consultant gastroenterologist universiti sains malaysia, kota bahru kelantan email. Differentiating ischemic from nonischemic causes often is difficult, and.
1128 1452 568 1297 1556 1032 1312 1007 1204 229 45 585 82 976 495 1198 738 45 657 456 672 582 1586 512 1437 619 1441 1433 1268 506 704 1265 728 358 1226 166 1132 1452 24 657 1393 1423 97 56