Pain Characteristics in Patients with Unexplained Chest Pain and Patients with Ischemic Heart Disease

The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Box 457, SE-40530 Göteborg, Sweden.
European Journal of Cardiovascular Nursing (Impact Factor: 1.88). 06/2007; 6(2):130-6. DOI: 10.1016/j.ejcnurse.2006.06.003
Source: PubMed


Little scientific attention has been paid to providing a comprehensive multidimensional description of chest pain in patients with unexplained chest pain.
The aims of the present study were: (1) to describe the symptom chest pain, including the dimensions of intensity, quality, duration and location in patients with unexplained chest pain (UCP); and (2) to identify similarities and differences in how patients with UCP and patients with ischemic heart disease (IHD) describe chest pain.
A descriptive, correlational and comparative design. Totally 208 consecutive UCP patients and 40 IHD patients below 70 years of age participated. Pain was assessed using the instrument Pain-O-Meter.
The occurrence of chest pain was 79% (n=165) in UCP patients versus 60% (n=22) in the IHD patients (p=0.001). Patients with UCP reported greater pain intensity and used more sensory and affective words than IHD patients (p<0.01). Relationships between pain location and amount of body surface involved in the pain and pain intensity in both groups were found (p<0.001).
Our results showed some defining characteristics of the UCP group, but the many similarities between the two groups in their experience of chest pain made it impossible to clearly differentiate the groups' pain profiles.

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    • "These patients also use more commonly sensory and affective words than patients with ischemic heart disease [9]. NCCP patients view their condition as significantly less controllable and less understandable than those patients whose pains are of cardiac origin [11] [12] [13]. Despite a favorable long-term cardiovascular prognosis [12] [13] [14] [15], NCCP is a major public health concern that not all NCCP patients have good outcomes [16]. "
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    ABSTRACT: Objective: Noncardiac chest pain (NCCP) is seen more frequently in young population and in these patients loss of function is evolving in social and professional areas. The aim of the study is to evaluate the levels of anxiety and somatic perception in patients with chest pain presenting to cardiology clinic. Methods: Fifty-one patients with noncardiac chest pain and 51 healthy controls were included in the study. All participants performed self-report based health anxiety inventory (HAI), somatosensory amplification scale (SAS), and Toronto alexithymia scale (TAS). Results: The patient group had significantly higher scores on the SAS, HAI-1, and HAI-T scales compared to controls (P < 0.001, P = 0.006, and P = 0.038, resp.). SAS, HAI-1, and HAI-T scores were significantly higher in female patients than male (P = 0.002, 0.036, and 0.039, resp.). There were significant differences in all TAS subscale scores between two groups. Patients, who had total TAS score more than 50, also presented higher levels of health anxiety (P = 0.045). Conclusions: Anxiety, somatic symptoms, and the exaggerated sense of bodily sensations are common in patients with NCCP. These patients unnecessarily occupy the cardiology outpatient clinics. These negative results can be eliminated when consultation-liaison psychiatry evaluates these patients in collaboration with cardiology departments.
    Full-text · Article · May 2014 · BioMed Research International
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    • "The presence of stabbing pain showed a pLR of 3.65 if ACS was the target disease, 0.90 for stable CHD, and 0.69 for MI. However, only one study contributed to the diagnostic outcome ACS (18). The 95% confidence interval ranged from 0.45 to 29.94 and only 10 out of 248 patients presented with stabbing pain. "
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    ABSTRACT: Aim To determine the diagnostic value of single symptoms and signs for coronary heart disease (CHD) in patients with chest pain. Methods Searches of two electronic databases (EMBASE 1980 to March 2008, PubMed 1970 to May 2009) and hand searching in seven journals were conducted. Eligible studies recruited patients presenting with acute or chronic chest pain. The target disease was CHD, with no restrictions regarding case definitions, eg, stable CHD, acute coronary syndrome (ACS), acute myocardial infarction (MI), or major cardiac event (MCE). Diagnostic tests of interest were items of medical history and physical examination. Bivariate random effects model was used to derive summary estimates of positive (pLR) and negative likelihood ratios (nLR). Results We included 172 studies providing data on the diagnostic value of 42 symptoms and signs. With respect to case definition of CHD, diagnostically most useful tests were history of CHD (pLR = 3.59), known MI (pLR = 3.21), typical angina (pLR = 2.35), history of diabetes mellitus (pLR = 2.16), exertional pain (pLR = 2.13), history of angina pectoris (nLR = 0.42), and male sex (nLR = 0.49) for diagnosing stable CHD; pain radiation to right arm/shoulder (pLR = 4.43) and palpitation (pLR = 0.47) for diagnosing MI; visceral pain (pLR = 2.05) for diagnosing ACS; and typical angina (pLR = 2.60) and pain reproducible by palpation (pLR = 0.13) for predicting MCE. Conclusions We comprehensively reported the accuracy of a broad spectrum of single symptoms and signs for diagnosing myocardial ischemia. Our results suggested that the accuracy of several symptoms and signs varied in the published studies according to the case definition of CHD.
    Full-text · Article · Oct 2012 · Croatian Medical Journal
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    • "Noncardiac chest pain (NCCP) is very common in the general population; however, a patient's history and characteristics do not reliably distinguish between cardiac and esophageal causes of chest pain.1,2 When it comes to chest pain, the cardiologist's first priority is to exclude any acute life-threatening cardiovascular condition.3 "
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    ABSTRACT: Noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause. Noncardiac chest pain is a prevalent disorder resulting in high healthcare utilization and significant work absenteeism. However, despite its chronic nature, noncardiac chest pain has no impact on patients' mortality. The main underlying mechanisms include gastroesophageal reflux, esophageal dysmotility and esophageal hypersensitivity. Gastroesophageal reflux disease is likely the most common cause of noncardiac chest pain. Esophageal dysmotility affects only the minority of noncardiac chest pain patients. Esophageal hypersensitivity may be present in non-GERD-related noncardiac chest pain patients regardless if esophageal dysmotility is present or absent. Psychological co-morbidities such as panic disorder, anxiety, and depression are also common in noncardiac chest pain patients and often modulate patients' perception of disease severity.
    Full-text · Article · Apr 2011 · Journal of neurogastroenterology and motility
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