Chest
Clinical InvestigationsAtypical Chest Pain of Cardiac and Esophageal Origin
Section snippets
Study 1
One hundred and five consecutive patients with atypical pains in the chest have been studied to determine whether their pain was of esophageal or cardiac origin. In this study, esophageal and cardiac investigations were performed on all patients, and the subsequent diagnosis was based on the results of the tests conducted. History was evaluated using a prepared history sheet, and the questions that were asked indicated distribution of pain and precipitating and relieving factors, as well as
Study 1
In the 105 patients with atypical pain in the chest, the diagnosis of cardiac or esophageal disease was made from the results of the investigations performed, independent of the symptoms.
Group 1 (Esophageal Pain), These patients had a radiologically diagnosed hiatal hernia, manometric evidence of a hernia, or radiologic evidence of gastroesophageal reflux. A major component of their pain was reproduced by perfusion with esophageal acid. One patient had diffuse spasm of the esophagus, and in
Discussion
Atypical pain in the chest presents a common diagnostic problem. It is of importance because misdiagnosis leads to mismanagement, with the potential of serious complications. The reasons for labelling cardiac or esophageal pain as atypical are the distributions of pain or its precipitating and relieving factors.
Experience gained in the management of these 105 patients with atypical pain in the chest has shown that many of the patients were incorrectly diagnosed and treated over a period of
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Manuscript received January 24; revision accepted April 26.