Outcomes of patients dismissed from the hospital with non-cardiac chest pain

Apr 20, 2010

The growing number of Americans with cardiovascular disease has caused a heightened sensitivity in the evaluation of chest pain. In a study published in the April issue of Mayo Clinic Proceedings researchers reported that patients dismissed from the hospital with noncardiac chest pain continue to experience cardiac events, which may highlight a need for more aggressive cardiovascular risk factor management in this population.

Noncardiac chest pain is defined as a substernal chest pain in the absence of significant epicardial coronary artery stenoses. Noncardiac chest pain is attributed to a variety of disorders, including (GERD) and esophageal , panic attack, musculoskeletal pain and microvascular disease (cardiac syndrome).

Researchers identified 320 patients with a diagnosis of noncardiac chest pain to determine the frequency of gastrointestinal (GI) consultations and testing, and to identify the frequency of . All patients had a hospital admission diagnosis of unstable angina, subsequent inpatient cardiac evaluation and a dismissal diagnosis of noncardiac chest pain.

The first aim of this study was to determine the frequency of GI consultation and testing. After the initial diagnosis of noncardiac chest pain, 49 percent of patients were re-evaluated in the and 42 percent underwent repeated cardiology evaluations; only 15 percent had GI consultations. In regards to GI testing, 38 percent underwent esophagogastroduodenoscopy, 4 percent underwent manometry (13 tests), and 2 percent had pH probes (six probes).

"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," says Michael Leise, M.D., co-investigator in the Department of , Mayo Clinic.

The study's second aim was to report on overall mortality, specifically, cardiac death in patients with noncardiac chest pain. Although prognosis for patients with noncardiac chest pain is thought to be favorable, researchers found that previous data to support this view were limited. The total sample in this study did not display a significantly increased frequency of death compared with what would be expected in this community, but a substantial number of cardiac deaths occurred in an noncardiac chest pain population. "We speculate that cardiac death in patients with noncardiac chest pain may relate to overlapping risk factors for GERD and disease, including obesity, obstructive sleep apnea, diabetes mellitus and smoking," says Dr. Leise. Until cardiac death in this population is better understood, it is important to screen for cardiac risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus and aggressively manage these comorbid conditions.

Explore further: AMA: Gender inequality still exists in medicine

add to favorites email to friend print save as pdf

Related Stories

What is the etiology of cardiac syndrome X?

Dec 01, 2008

Non-cardiac chest pain remains a widespread symptom especially in western countries with a significant economic burden. Patients with chest pain and abnormal electrocardiographic (ECG) but normal coronary angiogram (i.e. ...

New methods needed to ID cardiac catheterization candidates

Mar 10, 2010

It's time to re-think how patients are selected for cardiac catheterization, say doctors at Duke University Medical Center, after reporting in a new study that the invasive procedure found no significant coronary artery disease ...

Recommended for you

Doctor behind 'free radical' aging theory dies

4 hours ago

Dr. Denham Harman, a renowned scientist who developed the most widely accepted theory on aging that's now used to study cancer, Alzheimer's disease and other illnesses, has died in Nebraska at age 98.

Mexican boy who had massive tumor recovering

14 hours ago

An 11-year-old Mexican boy who had pieces of a massive tumor removed and who drew international attention after U.S. officials helped him get treatment in the southwestern U.S. state of New Mexico is still recovering after ...

New medical device to make the mines safer

Nov 21, 2014

Dehydration can be a serious health issue for Australia's mining industry, but a new product to be developed with input from Flinders University's Medical Device Partnering Program (MDPP) is set to more effectively ...

US family gets $6.75 million in Botox case

Nov 20, 2014

A New York couple who said Botox treatment of their son's cerebral palsy left him with life-threatening complications and sued its manufacturer won a $6.75 million verdict from a federal jury on Thursday.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.