Extraesophageal manifestations of GERD, particularly asthma, noncardiac chest pain
, and hoarseness, are not uncommon consequences of reflux.
Panic disorder is a common cause of noncardiac chest pain
, and chest pain is a prominent feature of panic disorder. The presence of chest pain is an important predictor of care-seeking.
It has average sensitivity and specificity of 80% for reflux disease in general but the sensitivity is much lower in patients with angina-like chest pain. A better test for correlation of atypical symptoms with reflux is the 24-hour ambulatory pH probe (Figure 1). Esophageal manometry is also some- times useful in evaluation of atypical chest pain. However, many episodes of chest pain in these patients are associated with neither reflux nor a manometric abnormality. Recent investigation has focused on abnormal esophageal visceral afferent function in atypical chest pain. The entire evaluation of noncardiac chest pain
is made even more complex by the recent recognition of microvascular angina.
The poor specificity for myoglobin in large populations of chest pain patients presenting with noncardiac chest pain
(3, 20) was substantiated in the present study with a specificity of <80%.
Hence, one would anticipate that patients who receive the diagnosis of stable angina (DRG 140) or noncardiac chest pain
(DRG 143) would have shorter hospital LOSs, if clinicians used cardiac enzymes to make their disposition decision and if those enzymes were more rapidly available.
But after medical officials ordered an X-ray and reviewed it, they diagnosed Martineau with noncardiac chest pain
and discharged him from the hospital, according to the suit.
Conversely, the incidence of evacuation for patients who were diagnosed with abnormal resting ECG (4%), risk factor assessment (3%), noncardiac chest pain
(8%), and palpitations (6%) were significantly less than the overall 15% evacuation rate (P <.05).
(5.) Shelby RA, Somers TJ, Keefe FJ, Silva SG, McKee DC, She L, Waters SJ, Varia I, Riordan YB, Knowles VM, Blazing M, Blumenthal JA, Johnson P Pain catastrophizing in patients with noncardiac chest pain
: relationships with pain, anxiety, and disability.
A 2005 meta-analysis of 6 studies found the sensitivity and specificity of a proton-pump inhibitor (PPI) acid suppression test for the diagnosis of GERD in patients with noncardiac chest pain
were 80% (95% Cl, 71%-87%) and 74% (95% Cl, 64%83%), respectively.
The adjudicated reference diagnosis in the majority of patients with increased hs-cTnT concentration was noncardiac chest pain
and cardiac but noncoronary chest pain (Fig.
Patients with noncardiac chest pain
often have sharp stabbing pain that lasts a few seconds to 1-2 minutes, and the pain is not associated with exercise.
To answer this question, doctors at Children's Hospital Boston reviewed the records of 3,700 patients older than age six who had been seen in the cardiology clinic from January 1, 2000 through December 3, 2009 for noncardiac chest pain
. The children were then followed for up to 10 years.