Prevalence Of Non-cardiac Chest Pain Research Articles

Non-Cardiac Chest Pain: A Review of Environmental Exposure-Associated Comorbidities and Biomarkers

The prevalence of non-cardiac chest pain (NCCP) ranges from 13-33%. A majority of those presenting with a chief complaint of chest pain are found to have a diagnosis of NCCP. Aerodigestive diseases are a cause of NCCP, and billions of dollars are spent annually on the treatment of NCCP. Furthermore, NCCP can cause significant psychological stress. NCCP is commonly diagnosed when patients have chest pain despite a normal cardiac evaluation. The leading cause of NCCP is gastro-oesophageal reflux disease (GORD). GORD should be suspected in patients who report a history of acid regurgitation, cough, dysphagia, and bloating. Another common cause of NCCP is obstructive airway disease (OAD). A thorough history and review of the symptoms should be performed for those with suspected NCCP, especially because of the contributing end organs. It is known that environmental exposures can commonly cause GORD and OAD; however, NCCP has not been fully explored in the context of environmental exposure. Patients with a history of exposure to particulate matter can develop environmental-exposure-associated GORD and coexisting OAD. This narrative review aims to provide a practical overview of NCCP, its causes, their relation to environmental exposure, and associated biomarkers. The authors used a PubMed search that spanned 2003-2018 to accomplish this. Additionally, this review provides a broad overview of biomarkers of GORD-associated NCCP and OAD-associated NCCP due to environmental exposure.

Clinico-Demographic Characteristics of Cervical Spondylosis Patients Presented with Chest Pain

Background: The prevalence of non-cardiac chest pain is estimated to be more than 65.0% of all cases with chest pain.Objective: The objective of the present study was to see the clinic-demographics characteristics and investigational findings of cervical spondylosis patients presented with chest pain.Methodology: This cross-sectional study was carried out in the department of Physical Medicine & Rehabilitation at National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh from July 2012 to June 2013 for a period of one year. The diagnosis was made by detailed history, clinical examination and relevant investigations.Result: In this study, female (60%) were much more sufferer especially in much younger age group (41.67%). People from urban area (68.75%) and affluent status (41.67%) were more affected; also who were in anxiety-depressed state of mind (50%) and those who worked by neck bending posture (45.83%). All patients presented with chest pain (100%) & other associated symptoms like arm pain (41.67%), tingling sensation of left upper limb (22.91%), shoulder pain (25.0%) and scapular pain (16.67%). All (100%) patients had normal ECG finding. On the other hand, they (100.0%) had some finding in cervical spine X-ray; clinically the patient had painful neck movement (75.0%). A specific test for cervical radiculopathy “spurling maneuver” was positive in (22.91%).Conclusion: Through chest pain due to cervical disc disease widely reported but remains under recognized. So careful evaluation of patient for chest pain might have saved the patient for admission and various expensive invasive procedure.Journal of Current and Advance Medical Research 2018;5(2):55-59

The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: a Northern Ireland based study

BackgroundThe aim of this study was to assess the frequency of chest pain presentations and the subsequent non-cardiac chest pain diagnoses in an emergency department (ED) over a 3 year period.MethodsAdministrative data on ED attendances to an urban general hospital in Northern Ireland between March 2013 and March 2016 were used. Data were coded and analysed to estimate frequencies of ‘chest pain’ presentation and the subsequent diagnoses for each year.ResultsBoth chest pain presentations and chest pain presentations with a subsequent diagnosis of unknown cause increased each year. In total, 58.7% of all chest presentations across 3 years resulted in a non-cardiac diagnosis of either ‘anxiety’, ‘panic’ or ‘chest pain of unknown cause’.DiscussionThere is a significant amount of patients in the ED leaving with a non-cardiac diagnosis, following an initial presentation with chest pain. ConclusionGiven the link between non-cardiac chest pain and frequent use of services, the degree of repeat attendance should be investigated.

Differential diagnosis "non-cardiac chest pain"

Non cardiac chest pain (NCCP) are recurrent angina pectoris like pain without evidence of coronary heart diesease in conventional diagnostic evaluation. The prevalence of NCCP is up to 70% and may be detected in this order at all levels of the medical health care system (general practitioner, emergency department, chest pain unit, coronary care). Reduction of quality of life in NCCP is comparable, partially even higher compared to cardiac chest pain. Reasons for psychological strain are symptom recurrence in app. 50%, nonspecific diagnosis with resulting uncertainty and insufficient integration of other medical disciplines in diagnostic work-up. Managing of patients with NCCP has to be interdisciplinary because non cardiac causes of chest pain may be found frequently. This are musculosceletal in app. 40%, gastrointestinal in app. 20%, psychiatric in app. 10% and pulmonary and mediastinal diseases in app. 5% of cases. Also gastroenterological expertise is required because here gastroesophageal reflux disease (GERD) in app. 60%, hypercontractile esophageal motility disorders with nutcracker, jackhammer esophagus or distal esophageal spasmus or achalasia in app. 20% and other esophageal alterations (e. g. infectious esophageal inflammation, drug-induced ulcer, rings, webs, eosinophilic esophagits) in app. 30% of cases may be detected as cause of chest pain may. This implicates that regular interdisciplinary round wards and interdisciplinary management of chest pain units are mandatory.

The head says yes but the heart says no: what is non-cardiac chest pain and how is it managed?

### Learning objectives Chest pain is common and usually non-cardiac in origin. The lifetime population prevalence of non-cardiac chest pain (NCCP) is approximately 20–33%1–7 compared with approximately 6–7% for angina.3...

Chest pain - not always the heart! Clinical impact of gastrointestinal diseases in non-cardiac chest pain

Non cardiac chest pain (NCCP) are recurrent angina pectoris like pain without evidence of coronary heart disease in conventional diagnostic evaluation. The prevalence of NCCP is up to 70 % and may be detected in this order at all levels of the medical health care system (general practitioner, emergency department, chest pain unit, coronary care). Reduction of quality of life in NCCP is comparable, partially even higher compared to cardiac chest pain. Reasons for psychological strain are symptom recurrence in app. 50 %, nonspecific diagnosis with resulting uncertainty and insufficient integration of other medical disciplines in diagnostic work-up. Managing of patients with NCCP has to be interdisciplinary because non cardiac causes of chest pain may be found frequently. Especially gastroenterological expertise is required because in 50 - 60 % of cases gastroesophageal reflux disease (GERD), in 15 - 18 % hypercontractile esophageal motility disorders with nutcracker, jackhammer esophagus or distal esophageal spasmus or achalasia and in 32 - 35 % other esophageal alterations (e. g. infectious esophageal inflammation, drug-induced ulcer, rings, webs, eosinophilic esophagitis) as cause of chest pain may be detected. This implicates that regular interdisciplinary round wards and management of chest pain units are mandatory.

Visceral pain: the importance of pain management services.

Visceral pain: the importance of pain management services.

Meta-analysis: the epidemiology of noncardiac chest pain in the community

Prevalence of, and risk factors for, noncardiac chest pain in the community have not been well studied. To conduct a systematic review and meta-analysis to examine these issues. MEDLINE, EMBASE and EMBASE Classic were searched (up to March 2011) to identify population-based studies reporting prevalence of noncardiac chest pain in adults (≥15 years) according to self-report, questionnaire or specific symptom-based criteria. Prevalence of noncardiac chest pain was extracted for all studies, and according to study location and certain other characteristics including presence or absence of gastro-oesophageal reflux disease (GERD) symptoms, where reported. Pooled prevalence overall, as well as odds ratios (OR), with 95% confidence intervals (CIs) were calculated. Of 18 articles evaluated, 16 reported prevalence of noncardiac chest pain in 14 separate populations, containing 24 849 subjects. Pooled prevalence of noncardiac chest pain in all studies was 13% (95% CI 9-16). The prevalence of noncardiac chest pain was higher in Australian studies and in studies using a questionnaire to define its presence, compared with those using Rome I or II criteria. Prevalence was no different in women vs. men (OR 0.99; 95% CI 0.82-1.20). The prevalence was markedly higher in subjects who also reported GERD (OR 4.71; 95% CI 3.32-6.70) and increased according to frequency of GERD symptoms. Pooled prevalence of noncardiac chest pain in the community was 13%, but there were few studies. Rates did not appear to differ according to gender or age. Presence of GERD was strongly associated with noncardiac chest pain.

Noncardiac Chest Pain in Young Patients: Author's Reply

TO THE EDITOR: The prevalence of noncardiac chest pain (NCCP) differs by the type of study performed: hospital-based studies, community-based studies or general practice studies. In the previous two studies,1,2 we reported that 38%-41% of NCCP in average aged subjects had gastroesophageal reflux disease (GERD) diagnosed by endoscopy and 24-hour esophageal pH monitoring, with similar protocol to this study on young aged NCCP.3 Comparing with our previous data, our present ratio of GERD-related NCCP (30%) was low, although the young age is one of the potential risk factors for NCCP.4 In this study, gastroenterologic causes such as peptic ulcer disease, gastrointestinal surgery and liver disease were excluded. Several pathophysiological mechanisms of NCCP have been suggested including GERD, esophageal motility disorders, visceral hyperalgesia and psychiatric disturbances and especially little are known about the characteristics of NCCP related to non GERD. Our data suggest that there may be more possibilities of other pathophysiological mechanisms except GERD in the young aged NCCP such as visceral hyperalgesia, psychiatric disturbances and so on. Therefore, as mentioned by the editor, management of the rest of the NCCP patients with non GERD is very important. The recent prospective case-control study by Lee et al5 suggested a new serotonin-norepinephrine reuptake inhibitor to aid in establishing the strategy for management by showing significantly improved symptoms in 52% of young adult patients with functional chest pain. In this study, typical GERD symptoms were more frequent in NCCP patients with GERD than in NCCP patients with non GERD (78% vs 29%). Therefore, typical GERD symptoms as well as proton pump inhibitor test may be a fair predictor for GERD-related NCCP in young aged patients, despite the relatively low prevalence of GERD-related NCCP. In addition, the long-term natural history of NCCP is one of our major concerns, so we need to monitor these NCCP patients more thoroughly.

Clinical Distinct Features of Noncardiac Chest Pain in Young Patients

Background/AimsNoncardiac chest pain (NCCP) is a very common disorder world-wide and gastroesophageal reflux disease (GERD) is known to be the most common cause. The prevalence of NCCP may tend to decrease with increasing age. However, there is little report about young aged NCCP. The aim of this study was to examine the prevalence of GERD and to evaluate the efficacy of proton pump inhibitor (PPI) test in the young NCCP patients.MethodsThirty patients with at least weekly NCCP less than 40 years were enrolled. The baseline symptoms were assessed using a daily symptom diary for 14 days. Esophago-gastro-duodenoscopy (EGD) and 24 hr esophageal pH monitoring were performed for the diagnosis of GERD and esophageal manometry was done. Then, patients were tried with lansoprazole 30 mg twice daily for 14 days, considering positive if a symptom score improved ≥ 50% compared to the baseline.ResultsNine (30%) of the patients were diagnosed with GERD at EGD and/or 24 hr esophageal pH monitoring, also, 3 (10%) were diagnosed with GERD-associated esophageal motility disorder and 3 (10%) were non GERD-associated. Concerning PPI test, GERD-related NCCP had a higher positive PPI test (n = 8, 89%) than non GERD-related NCCP (n = 5, 24%) (p = 0.002).ConclusionsIn young patients with NCCP, a prevalence of GERD diagnosed using EGD and/or 24 hr esophageal pH monitoring was 30%. PPI test was very predictable on diagnosis of GERD-related NCCP, thus, PPI test in young NCCP patients may assist to the physician's clinical judgment of NCCP.

Prevalence of noncardiac chest pain in Japanese patients with recurrent chest pain

Prevalence of noncardiac chest pain in Japanese patients with recurrent chest pain