Non-Cardiac Chest Pain of Non-Esophageal Origin
Chest pain is a common clinical problem that can be caused by a broad spectrum of diseases other than coronary artery disease or acid reflux. The diagnosis of non cardiac, non esophageal chest pain can be challenging. The chronic occurrence of chest pain
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Non-Cardiac Chest Pain of Non-Esophageal Origin Cristina Almansa and Sami R. Achem
Abstract
Chest pain is a common clinical problem that can be caused by a broad spectrum of diseases other than coronary artery disease or acid reflux. The diagnosis of non cardiac, non esophageal chest pain can be challenging. The chronic occurrence of chest pain interferes with the daily life routine, mood and productivity of those affected by this condition and therefore implies an enormous socio-economic burden in the community. This chapter offers an overview of some of the most relevant conditions that need to be considered in the differential diagnosis of a patient presenting with chest pain, once that a cardiac and/or an esophageal origin of the symptom has been properly excluded. Keywords
Chest pain • Epigastric pain • Gastric volvulus • Peptic ulcer • Pneumoperitoneum • Cholecystitis • Choledocolitiasis • Cholangitis • Sphincter of Oddi dysfunction • Pancreatitis • Pancreatic pseudocyst • Pleural fistula • Musculoskeletal pain • Chostochondritis • Tietze syndrome • Precordial catch syndrome • Bornholm disease • Muscle injury • Pseudoangina • Thoracic outlet syndrome • Pneumonia • Pleuritis • Pleural effusions • Pulmonary embolism • Pneumothorax • Pneumomediastinum • Pulmonary arterial hypertension • Anxiety • Panic disorder • Fibromyalgia • Acute aortic syndrome • Sickle cell disease • Drug induced chest pain • Herpes zoster
Introduction Non-cardiac chest pain (NCCP) can be defined as chest pain resembling angina but without objective evidence of coronary artery disease [1]. NCCP is a source of concern for physicians and patients alike. Chest pain is a common clinical problem. A recent meta-analysis estimated a global prevalence of 13 % (95 % CI 9–16), identifying higher rates in studies performed in Australia, where the pooled prevalence was 16 % (95 % CI 0.2–50) [2]. The prevalence of NCCP has not been studied worldwide, for instance there is lack of
C. Almansa, MD, PhD (*) • S.R. Achem, MD, FACP, FACG, AGAF Division of Gastroenterology, Mayo College of Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA e-mail: [email protected]; [email protected] J.C. Kaski et al. (eds.), Chest Pain with Normal Coronary Arteries, DOI 10.1007/978-1-4471-4838-8_2, © Springer-Verlag London 2013
information from certain regions such as Africa or Centro America. The results of different surveys suggest that NCCP affects equally men and women of all ages [2]. A Chinese study reported that the prevalence of NCCP might be inversely related to the socio-economic status but this data has not been confirmed in other populations [3]. Despite the high prevalence of the problem, an Australian study suggests that only a small proportion of patients consult a physician [4]. Interestingly, this survey identified that males were two-times more likely to consult than females, maybe because they were more aware of the risk of heart diseases than their females counterparts [4]. NCCP is also an important cause of wo
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