Introduction: Non-cardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health-care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP. Thus the typical symptoms of reflux, such as heartburn and regurgitation, when present as predominant symptoms are quite specific for diagnosing GERD but in patients with NCCP the clinical diagnosis of reflux is difficult, and invasive methods or the omeprazole test are required for its detection. The aim of the present study was to evaluate the role of clinical presentation when diagnosing GERD among patients with NCCP.
Methods: Patients with NCCP underwent upper endoscopy, Bernstein and omeprazole tests. The patients were divided into two groups based on GER- or non-GER-related chest pain, and clinical presentation was compared between these two groups. Gastroesophageal reflux disease was considered positive when at least two methods were positive.
Results: From 78 NCCP patients (41 male; mean age 50.4 +/- 2.3 years), the chest pain was related to GERD in 35 patients (44.8%). The two groups were the same based on sex and age. The chest pain severity, site, radiation and relation to food, exercise, and sleep were equal in the two groups, except for two symptoms: pain that was relieved by antacid (P < 0.031) and presence of classical reflux symptoms (P < 0.009), seen in the GERD patients. With regard to recent patient history, heartburn and regurgitation symptoms were seen more frequently in GERD patients (P < 0.036 and P < 0.002, respectively).
Discussion: Clinical presentation is important in diagnosing GERD in NCCP. Although the chest pain is the same in reflux- and non-reflux-related NCCP, the symptoms of heartburn or regurgitation in the present or recent patient history are diagnostic for GERD-related chest pain.
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http://dx.doi.org/10.1111/j.1440-1746.2006.04416.x | DOI Listing |
Circ Cardiovasc Qual Outcomes
January 2025
Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.).
Background: The High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) pathway risk stratifies emergency department patients with possible acute coronary syndrome. This study aims to determine if the High-STEACS hs-cTnT (high-sensitivity cardiac troponin T) pathway can achieve the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (CDMI) in a multisite US cohort of patients with and without known coronary artery disease (CAD).
Methods: A secondary analysis of the STOP-CP (High-Sensitivity Cardiac Troponin T [Gen 5 STAT Assay] to Optimize Chest Pain Risk Stratification) cohort, which enrolled adult emergency department patients with possible acute coronary syndrome at 8 US sites (January 25, 2017-September 6, 2018).
Cureus
December 2024
Anesthesiology, Showa University Northern Yokohama Hospital, Yokohama, JPN.
Flail chest is a life-threatening condition characterized by multiple rib fractures that result in a partially free rib cage. Thoracic paravertebral block (TPVB) allows visualization of the needle tip under ultrasound guidance and can be safely performed, unlike epidural anesthesia where the needle tip cannot be visualized. Here, we describe a case of flail chest in whom TPVB was used, as it provides the same level of analgesia as epidural anesthesia and has a perfect analgesic effect.
View Article and Find Full Text PDFCureus
December 2024
Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, IRQ.
Cough-induced rib fractures are rare conditions and are seldom reported in the medical literature. This case involves a 54-year-old postmenopausal woman who experienced a persistent dry cough lasting 16 days, which progressed to acute, localized chest pain in the right hemithorax. Symptoms started after an initial chest infection.
View Article and Find Full Text PDFJTCVS Open
December 2024
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
Objective: Recent advancements in chest tube technologies have gained interest for their ability to enhance postoperative recovery via reduction of retained blood syndrome after cardiothoracic surgery. The present study investigates the effect of the Centese Thoraguard automated line-clearance chest tube system on postoperative pain and recovery after cardiac surgery.
Methods: This was a single-center retrospective review of 1771 adult patients undergoing nonemergency cardiac surgery between January 2021 and December 2022.
Cardiol Young
January 2025
Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, USA.
A 16-year-old male with newly diagnosed granulomatosis with polyangiitis presented to the emergency room with chest pain. He was found to have a myocardial infarction involving the right coronary artery and the left circumflex artery. He underwent mechanical thrombectomy and stent placement without significant sequelae.
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