Abstract
The differential diagnosis of chest pain, one of the most frequent symptoms referred in the emergency department, includes cardiac and noncardiac causes and represents a difficult challenge for clinicians. Noncardiac chest pain can be defined as the recurrence of chest pain episodes indistinguishable from coronary events after the exclusion of a cardiac cause. It may be of musculoskeletal, pulmonary, gastroenterological, psychosomatic or neurological aetiology, oesophageal disorders representing the most common detectable cause. In this report we describe a rare case of chest pain which appeared after dinner, due to an oesophageal spasm caused by the anomalous course of the carotid arteries. The case is relevant because it describes a very uncommon variant of the physiological course of the carotid arteries, and because it is unusual that a retro thoracic vascular abnormality can be related to the appearance of chest pain without dysphagia. Chest pain which appears after dinner in our case is probably due to the unusual anatomic connection between oesophagus and carotid arteries that probably begins to make stronger when the patient undertakes the supine position: for that reason nocturnal chest pain promptly relieves after the assumption of orthostatic or semi orthostatic decubitus. In conclusion, in a patient who refers the sudden appearance of nocturnal chest pain certainly unrelated to coronary artery disease, the physicians should consider the involvement of oesophageal system, maybe determined by vascular course abnormalities.
Highlights
INTRODUCTIONOf the patients referring to the emergency department [1]
Chest pain is one of the most frequent clinical symptoms of the patients referring to the emergency department [1]
The differential diagnosis of chest pain, one of the most frequent symptoms referred in the emergency department, includes cardiac and noncardiac causes and represents a difficult challenge for clinicians
Summary
Of the patients referring to the emergency department [1] It is a frequent manifestation in both cardiac and noncardiac diseases, and the differential diagnosis represents one of the most difficult challenges for clinicians, including many conditions affecting thoracic and abdominal organs [2]. Failure to recognize potentially serious conditions such as acute coronary syndrome, aortic dissection, pneumothorax, or pulmonary embolism can rise to severe complications [3], otherwise, the inappropriate research of noncardiac causes of chest pain can determine needless hospital admissions, expansive tests, painful procedures, and anxiety [4]. The diagnosis of noncardiac chest pain is provided by the recurrence of chest pain episodes indistinguishable from corononary events after that a reasonable flow-chart allows to exclude a cardiac cause [5], until to the performance of coronary angiography, which shows a normal or an insignificant degree of obstruction in up to 30% of the cases [6]. In this report we describe a uncommon case of nocturnal chest pain which appeared after dinner, without any involvement of coronary arteries, and was relieved by the changes of decubitus
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