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Belching as a symptom of myocardial ischaemia
  1. Jason Smith, Specialist Registrar in Emergency Medicine,
  2. Simon Carley, Specialist Registrar in Emergency Medicine
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

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Report by Jason Smith, Specialist Registrar in Emergency Medicine Checked by Simon Carley, Specialist Registrar in Emergency Medicine

Clinical scenario

A 60 year old man attends the emergency department with chest pain. He also gives a history of belching since the onset of the pain. His initial ECG is normal. You wonder if the symptom of belching has any prognostic value in the diagnosis of cardiac chest pain, or is more suggestive of a gastrointestinal cause.

Three part question

In [patients with chest pain] is [belching a useful discriminatory symptom] of [myocardial ischaemia]?

Search strategy

Medline 1966 to 08/01 using the OVID interface. [(exp myocardial infarction OR myocardial infarction.mp. OR MI.mp OR exp myocardial ischemia OR myocardial ischemia.mp OR myocardial ischaemia.mp OR exp angina pectoris) AND (exp eructation OR eructation.mp OR belching.mp OR eructonesius.mp)] LIMIT to human and english.

Search outcome

Seven articles were found of which five were irrelevant or of insufficient quality. The two remaining papers are shown in the table.

Comment(s)

There are no randomised trials that answer the question. The best evidence would appear to come from two questionnaire studies, which show that belching is a symptom of myocardial ischaemia or infarction in a significant number of patients. It should not be assumed, therefore, that patients who have both chest pain and belching are more likely to be suffering from a non-cardiac cause.

Clinical bottom line

Belching is a recognised symptom of myocardial ischaemia or infarction.

Table 7

Report by Jason Smith, Specialist Registrar in Emergency Medicine Checked by Simon Carley, Specialist Registrar in Emergency Medicine

References

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