Summary

Background : Little is known about the prevalence and importance of non-cardiac chest pain in the general population.



Aim : To evaluate the magnitude and impact of this condition.



Methods : A validated self-report questionnaire was mailed to a sample of 1000 residents of Penrith, selected randomly from the electoral rolls. Symptoms, risk factors, psychological distress, quality of life and demographics were measured.



Results : The response rate was 73% (n = 672; mean age, 46 years; 52% female). Chest pain ever was reported by 39% of the population; 7% reported a history of myocardial infarction and 8% a history of angina. Two hundred and nineteen (33%) cases were classified as non-cardiac chest pain; only 23% had consulted a physician about chest pain in the previous year. The only independent risk factor for non-cardiac chest pain was the frequency of heartburn (odds ratio, 1.74; 95% confidence interval, 1.08–2.79; P = 0.02). None of the gastrointestinal (heartburn, dysphagia, acid regurgitation) or psychological (anxiety, depression, neuroticism) risk factors were significantly associated with consulting for non-cardiac chest pain.



Conclusions : Non-cardiac chest pain is remarkably common in the general population and negatively impacts on the quality of life. Gastro-oesophageal reflux disease is a key risk factor for non-cardiac chest pain in the community. Health care seeking for non-cardiac chest pain remains unexplained.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2036.2003.01557.x

Non-cardiac chest pain: prevalence, risk factors, impact and consulting — a population-based study

https://www.rima.org/web/medline_pdf/AmJGastroenterol_1226-32.pdf

Diagnostic and Therapeutic Use of Proton Pump Inhibitors in Non-Cardiac Chest Pain: A Metaanalysis

Recurrent chest pain in the absence of coronary artery disease is a common problem that sometimes leads to excess use of medical care. Although many studies examine the causes of pain in these patients, few clinical trials have evaluated treatment. The studies reviewed in this paper provide an insight into the effectiveness of psychological interventions for this group of patients.
The objective of this review is to investigate psychological treatments for non-specific chest pain (NSCP) with normal coronary anatomy.

/pdf/psychological-interventions-for-symptomatic-management-of-4angxa39ev.pdf

Psychological interventions for symptomatic management of non‐specific chest pain in patients with normal coronary anatomy

SUMMARY

Background : Non-cardiac chest pain is a common condition affecting approximately one-quarter of the population during their lifetime, but the long-term economic costs of non-cardiac chest pain are poorly defined.



Methods : A MEDLINE and Current Contents search was performed from 1991 to 2002 using specific keywords. All major articles on the subject of non-cardiac chest pain in this period were reviewed and their reference lists searched.



Results : Limited studies suggest that the majority of those with non-cardiac chest pain do not consult a doctor regarding their symptoms; the drivers of health care seeking are not known. The impact on the quality of life in consulters can be severe, with as many as 36% reporting much lower quality of life levels. The diagnosis of non-cardiac chest pain can be difficult due to the heterogeneous nature of the condition, with significant overlap of gastro-oesophageal reflux disease, chest wall syndromes and psychiatric disease, which may drive up the costs of management. The prognosis appears to be good, but there are conflicting results in long-term studies.



Conclusions : The costs of non-cardiac chest pain to the health care system are likely to be large and represent a significant proportion of each Western country's health care budget. Further studies are required to determine methods of reducing health care costs.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2036.2002.01296.x

The burden of illness of non-cardiac chest pain

Summary

Aims : To determine the predictors of health care seeking, assess the types of health care professional consulted and to calculate the work absenteeism rates and interruptions to daily activities among non-cardiac chest pain patients.



Methods : A total of 212 patients who presented to a Tertiary Hospital Emergency Department over a 1-year period with acute chest pain were assessed according to a standard diagnostic protocol and completed the Chest Pain Questionnaire (CPQ).



Results : In the previous 12 months prior to presentation to the Emergency Department, 78% of patients had seen a health care professional for chest pain. The main health care professionals seen were general practitioners (85%), cardiologists (74%) and gastroenterologists (30%). Work absenteeism rates because of non-cardiac chest pain were high (29%) as were interruptions to daily activities (63%). Multiple logistic regression found that acid regurgitation was the only independent predictive symptom associated with consulting for non-cardiac chest pain (OR = 3.97, 95% CI: 1.25–12.63).



Conclusions : Consulting for chest pain is common is this group of patients. The type of health care professional seen appears to be moderated by the frequency and severity of reflux symptoms among these chest pain patients. Work absenteeism and interruptions to daily activities is high among chest pain sufferers.

Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities.

Chest pain is common: one in four of the population have an episode annually. Of those who present to hospital, nearly two-thirds have noncardiac chest pain. More than half of these cases might have gastroesophageal reflux disease. Opinion differs over what is the most appropriate application of current investigatory methods. Evidence suggests that, once cardiac disease is ruled unlikely, empiric use of a proton pump inhibitor is an option; if acid suppression fails, detailed investigations as clinically indicated can be considered. A range of esophageal investigations is available, including 24-hour or 48-hour esophageal pH testing and esophageal manometry, as well as provocative tests, but there is no consensus as to which methods are the most useful. Psychiatric evaluation is not routine, but psychiatric or psychological disorders are common. Musculoskeletal disorders are also common, but are frequently overlooked. It is possible to subject patients to a comprehensive set of investigations before empiric therapy, but recent studies have failed to demonstrate an improved outcome using this exhaustive approach. A new tactic is required, with less attention spent on absolute diagnostic accuracy and more emphasis on optimizing the long-term clinical outcome in patients with noncardiac chest pain. It is possible that the targeted use of multiple drug trials in a policy of 'therapy as investigation' might be a superior methodology.

Diagnosis and treatment of noncardiac chest pain.

/pdf/non-cardiac-chest-pain-1nnke4woks.pdf

Non-cardiac chest pain

OBJECTIVE: To evaluate trends in pacemaker mode prescription from 1984 to 1994 with particular reference to the changes in pacemaker mode prescription for patients aged 80 years and older at implant. DESIGN: Prospective evaluation of indications for pacing and pacemaker mode prescription in all patients undergoing new pacemaker implantation from 1992 to 1994. Comparison with retrospectively obtained data for patients paced from 1984 to 1991. SETTING: Tertiary referral cardiothoracic centre. PATIENTS: Group 1: 2622 patients paced at one centre and entered into the national pacing database from 1984 to 1991. Group 2: 1088 consecutive patients paced from 1992 to 1994. RESULTS: Use of atrial (AAI) and dual chamber (DDD) pacemakers increased progressively in patients of all ages from 1984 to 1994. There was an increase in the proportion of patients aged 80 years and older from 25.4% (group 1) to 40.5% (group 2). Patients of all ages in group 2 were more likely to receive DDD units for atrioventricular block (odds ratio (95% confidence interval) (CI) 9.0 (7.0 to 11.5)) and AAI or DDD units for sinus node disease (odds ratio (95% CI) 11.0 (7.7 to 15.8)) than those in group 1. Elderly patients (age > or = 80 at implant) with atrioventricular block or sinus node disease and a suitable atrial rhythm were less likely to receive DDD or AAI pacemakers than younger patients in both groups. CONCLUSIONS: Use of atrial and dual chamber pacing modes has increased substantially in patients of all ages over the last decade. Although elderly patients represent an increasing proportion of the paced population, they remain less likely to receive atrial or dual chamber pacemakers than younger patients.

https://heart.bmj.com/content/heartjnl/75/5/518.full.pdf

Trends in pacemaker mode prescription 1984-1994: a single centre study of 3710 patients.

Editor—We are concerned about one of the sweeping conclusions in the editorial on non-cardiac chest pain.1 We do not agree that “providing a diagnosis may be less important than addressing a patient's concerns and fears.” Providing a diagnosis is probably the most important part of the care of such patients.

Evidence shows that angiography fails to relieve the anxiety of patients,2 but the psychological and psychiatric complications of chest pain may be at least partially related to general practitioners' inability to provide a definite diagnosis. Continued prescription of antiangina drugs, and possibly failure to investigate further, contribute to continued anxiety. Patients with chest pain of non-cardiac origin need a label to hang on to.

Because there is often more than one diagnosis, we suggest using the label “chest pain of unexplained origin.” A multidisciplinary approach could be useful, with particular attention being paid to psychological factors.3 Nijher et al say that an alternative non-cardiac diagnosis can be difficult to make, but it is often possible: a definite diagnosis can be reached in up 85% of patients.4 The impact of chest pain clinics is uncertain, and follow up for patients with non-cardiac chest pain may be of value.5 Certainly, as the authors say, these clinics might worsen the situation if adequate follow up is not arranged.

Adequate investigation for other physical causes of chest pain must be part of a comprehensive approach to this difficult problem.

/pdf/non-cardiac-chest-pain-patients-need-diagnoses-32v0kp83lx.pdf

Non-cardiac chest pain. Patients need diagnoses.

Popular Tasks used by Researchers

How can I help with your research?

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

We encountered an error while loading the panel. Please try refreshing the page.

Something went wrong

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

Anyone with the link can view this chat. You can switch it back to private anytime.

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

David S Coulshed

Author Tools

Chat about Author