Chest wall syndrome. A common cause of unexplained cardiac pain

Epstein, Stephen E.

doi:10.1001/jama.241.26.2793

Cited by 42 publications

(11 citation statements)

References 14 publications

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“…A chest wall pathology in angina pectoris has been described in early studies [ 17] with a classical description by Davis & Ritvo of osteoarthritis of the cervicodorsal spine simulating coronary artery disease [ 19]. Newer studies have also dealt with this subject in case reports [ 16, 20]. In a recent study of 100 patients with chest pain and normal coronary arteriography, 69 were found to have chest wall tenderness compared with none of 25 control patients with arthritis but no symptoms of chest pain [ 35].…”

Section: Discussionmentioning

confidence: 99%

Musculo–skeletal pathology in patients with angina pectoris and normal coronary angiograms

Fröbert

Fossgreen

Søndergaard‐Petersen

et al. 1999

Journal of Internal Medicine

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Purpose. To evaluate the role of the musculo-skeletal apparatus in patients with angina pectoris despite normal coronary angiograms. Design. A survey of patients and controls investigated by blinded observers. Setting. A tertiary cardiologic referral centre. Subjects. Thirty women and 18 men (mean age 52.9 years) with chest pain of an average duration of 3 years and 11 months were investigated. All had normal resting electrocardiograms. No patients showed evidence of left ventricular hypertrophy or valvular heart disease on echocardiography and all had a normal coronary angiogram. All had left ventricular ejection fraction >50%, and none had signs of coronary vasospasm. Eighteen healthy persons (10 women and eight men, mean age 51.2 years) served as controls. Main outcome measures.The group frequency of chest wall complaints, spinal radiograph and physical examination findings; pressure pain thresholds. Results. The patients had significantly more complaints of pain from the neck, chest, and thoracic spine, and sensations and pain radiating to the arms than the controls. The patients had more degenerative findings on radiograph than the controls, mainly at levels C4-C7. Physical examination showed that abnormal findings were significantly more frequent in patients than in the control group in the anterior and posterior chest wall, in the spine at levels Th1-Th6 and in the muscles of the neck and shoulder girdle. There were no statistically significant differences in pain thresholds or in neurological examination. Conclusion. The musculo-skeletal abnormalities observed in the patients could include reflex mechanisms. Whether the abnormal findings are mainly responsible for the angina pectoris symptoms or merely epiphenomena warrants further study.

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Section: Discussionmentioning

confidence: 99%

Musculo–skeletal pathology in patients with angina pectoris and normal coronary angiograms

Fröbert

Fossgreen

Søndergaard‐Petersen

et al. 1999

Journal of Internal Medicine

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“…Likewise, in our study, 73% of women referred for CA did not have obstructive CAD. The mechanisms for women to have frequent and chronic chest pain without angiographic CAD has been attributed to vasospasms in the setting of endothelial dysfunction (27), esophageal pain (28), chest wall syndrome (29), and psychosomatic causes (30). In addition, ischemia and chest pain may result from disease of the small rather than the large epicardial vessels in the setting of diabetes, hypertension, collagen disease, and without concomitant predisposing diseases (syndrome X).…”

Section: Figure 2 Patient Examples Of Cmr Stress Test In Womenmentioning

confidence: 99%

Value of Cardiovascular Magnetic Resonance Stress Perfusion Testing for the Detection of Coronary Artery Disease in Women

Klem

Greulich

Heitner

et al. 2008

JACC: Cardiovascular Imaging

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“…As a consequence, they place a large burden on health care resources and it has been estimated that this problem costs the US economy many billions of dollars per year. 2 3 A variety of factors have been implicated in the pathogenesis of NCCP, including oesophageal reflux, oesophageal motor dysfunction, 4 visceral hypersensitivity, 5 musculoskeletal problems, 6 and psychological factors. 7 To complicate matters further, there is some evidence to suggest that even when the coronary arteries are angiographically normal, there may be abnormalities of either coronary flow or the microvascular circulation.…”

mentioning

confidence: 99%

Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy

Jones

Cooper²,

Miller³

et al. 2006

Gut

126

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Background: Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. Aims: This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with anginalike chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. Patients and methods: Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. Results: Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. Conclusion: Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.

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Chest wall syndrome. A common cause of unexplained cardiac pain

Cited by 42 publications

References 14 publications

Musculo–skeletal pathology in patients with angina pectoris and normal coronary angiograms

Musculo–skeletal pathology in patients with angina pectoris and normal coronary angiograms

Value of Cardiovascular Magnetic Resonance Stress Perfusion Testing for the Detection of Coronary Artery Disease in Women

Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy

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