Background-No cause has been determined for chest pain that is neither cardiac nor oesophageal in origin. Aims-To compare the prevalence of lifetime psychiatric disorders and current psychological distress in three consecutive series of patients with chronic chest or abdominal pain. Patients-Thirty nine patients with noncardiac chest pain and no abnormality on oesophagogastroduodenoscopy, oesophageal manometry, and 24 hour pH monitoring; 22 patients with non-cardiac chest pain having endoscopic abnormality, oesophageal dysmotility, and/or pathological reflux; and 36 patients with biliary colic.
Methods-TheDiagnostic Interview Schedule and the 28 item General Health Questionnaire were administered to all patients. Results-Patients with non-cardiac chest pain and no upper gastrointestinal disease had a higher proportion of panic disorder (15%), obsessive-compulsive disorder (21%), and major depressive episodes (28%) than patients with gallstone disease (0%, p<0.02; 3%, p<0.02; and 8%, p<0.05, respectively). In contrast, there were no diVerences between patients with noncardiac chest pain and upper gastrointestinal disease and patients with gallstone disease in any of the DSM-111 defined lifetime psychiatric diagnoses. Using the General Health Questionnaire, 49% of patients with non-cardiac chest pain without upper gastrointestinal disease scored above the cut oV point (that is, more than 4), which was considered indicative of non-psychotic psychiatric disturbance, whereas only 14% of patients with gallstones did so (p<0.005). The proportions of such cases were however similar between patients with non-cardiac chest pain and upper gastrointestinal disease (27%) and patients with gallstones. Conclusions-Psychological factors may play a role in the pathogenesis of chest pain that is neither cardiac nor oesophagogastric in origin. (Gut 1998;43:105-110)
To overcome problems associated with the faxing of ECGs, we developed a telemedicine system providing fast transmission of ECGs between physicians and cardiologists at different locations. It digitized ECGs at a resolution of 300 dots/inch (118 dots/cm), processed them, and transmitted them over a standard telephone line in under one minute. The system also paged the cardiologist in order to direct him or her to the location where the ECG would be waiting for interpretation. The system enabled physicians at remote locations to consult using voice, images and simultaneous cursor pointers. A transmitting site was set up at the Medical Centre of the Ministry of Defence and a receiving site at the National University Hospital, about 5 km away. During a six-month trial, 200 ECG reports were transmitted from one site to the other. They were rated excellent in quality by the cardiologists, being virtually indistinguishable from the originals. Our telemedicine system transmits high-quality ECGs rapidly and at low cost.
The association of coronary artery spasm and myocardial bridging is very uncommon and may represent a distinct clinical entity. Three patients are described, presenting with acute coronary syndrome associated with myocardial bridging and coronary artery spasm. The relationship and respective roles of myocardial bridging and spasm, however, remain uncertain and may be consequent to a direct effect on endothelial function from the compressive effect of myocardial bridging. The role of intracoronary nitroglycerin in these patients is unresolved.
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