Original articleEsophageal dysfunction in patients with atypical chest pain investigated with esophageal scintigraphy and myocardial perfusion imaging: An outcome study
Section snippets
Study design and follow-up
This outcome study used a prospective descriptive design. All patients gave informed consent, and ethics committee approval was granted. The measured endpoints were cardiac events that included cardiac death, myocardial infarction, and revascularization procedures. The revascularization procedures included coronary artery bypass graft surgery, coronary angioplasty, and/or coronary artery stenting. Outcome was determined by patient telephone contact and by clinical details of regular follow-up
Results
Of the patients, 53 (50%) had ED but no IHD, 41 (39%) had both ED and IHD, 5 (5%) had normal ES and IHD, and 6 (6%) had neither ED nor IHD (Figure 1). The patients were stratified for risk of coronary artery disease (Table 1). Of the patients, 75% had a low or intermediate likelihood of significant CAD and 64% had a low or intermediate relative risk ratio. Of the 45 patients who were tested by Bruce protocol treadmill exercise stress testing, 19 were positive for ischemia and 19 had their
Discussion
The causes of chest discomfort are many. Most adults, particularly those over age 40 years, will have chest discomfort in one form or another at some time. Commonly, this is the result of ED, but such an assumption can prove fatal.8, 9 Our results indicate that in a group of 105 patients with atypical chest pain, only 11% did not have ED. Those with ED comprised 50% of patients who had underlying ED without coexisting IHD and 39% who had both ED and IHD. This demonstrates not only a high
Acknowledgements
The authors have indicated they have no financial conflicts of interest.
References (28)
- et al.
Value of non-invasive assessment of patients with atypical chest pain and suspected coronary spasm using ergonovine infusion and thallium-201 scintigraphy
Am J Cardiol
(1984) - et al.
Computer-assisted diagnosis in the non-invasive evaluation of patients with suspected coronary artery disease
J Am Coll Cardiol
(1983) - et al.
Effective risk stratification using exercise myocardial perfusion SPECT in womengender-related differences in prognostic nuclear testing
J Am Coll Cardiol
(1996) - et al.
Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain
J Am Coll Cardiol
(1994) - et al.
Comprehensive strategy for the evaluation and triage of the chest pain patient
Ann Emerg Med
(1997) - et al.
Potential cost effectiveness of initial myocardial perfusion imaging for assessment of emergency department patients with chest pain
Am J Cardiol
(1997) - et al.
Non-cardiac chest pain in the populationprevalence and impact
J Gastroenterol Hepatol
(1999) - et al.
Current concepts on pathophysiology, diagnosis and treatment of diffuse oesophageal spasm
Drugs
(2001) Chest pain
ABC of the upper gastrointestinal tract. Oesophagusatypical chest pain and motility disorders
BMJ
(2001)
Radionuclide esophageal transit study in detection of esophageal motor dysfunctioncomparison with motility studies (manometry)
J Nucl Med
Death due to unrecognised myocardial infarction causing left ventricular rupturecan we improve the diagnostic rate?
N Z Med J
Exercise myocardial perfusion SPECT in patients without known coronary artery diseaseincremental prognostic value and use in risk stratification
Circulation
Cited by (13)
Does acid reflux precipitate ischaemia in subjects with acute coronary syndrome?
2020, Cardiovascular Journal of AfricaGastroesophageal Reflux Disease and Coronary Heart Disease: Is There a “Mutual Burden” Syndrome?
2019, Russian Journal of Gastroenterology, Hepatology, ColoproctologyRadionuclide gastrointestinal transit tests
2016, Pediatric Neurogastroenterology: Gastrointestinal Motility and Functional Disorders in Children: Second EditionRadionuclide transit tests
2013, Pediatric Neurogastroenterology: Gastrointestinal Motility and Functional Disorders in ChildrenEnterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain
2013, Indian Journal of Nuclear MedicineNonprescription product therapeutics: Second edition
2011, Nonprescription Product Therapeutics: Second Edition