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[Differential diagnosis in acute chest pain and suspected myocardial infarction. A pilot study]
P Fruergaard1, J Launbjerg, J F Falch
1Medicinsk afdeling B, Centralsygehuset Hillerød.
Insights
Chest pain patients not experiencing acute myocardial infarction (AMI) often have underlying organic causes. A new investigation program successfully identified probable causes in 94% of non-AMI patients, aiding diagnosis.
Area of Science:
- Cardiology
- Diagnostic Medicine
Context:
- Chest pain is a common presenting complaint in emergency departments.
- A significant proportion of patients admitted for suspected acute myocardial infarction (AMI) are ultimately diagnosed with non-AMI conditions.
- Both AMI and non-AMI patients exhibit elevated long-term mortality post-discharge due to cardiac death.
Purpose:
- To evaluate a comprehensive investigation program for patients presenting with chest pain but ultimately diagnosed as non-AMI.
- To systematically identify potential organic causes of acute chest pain in a non-AMI cohort.
Summary:
- A pilot study involving 32 non-AMI patients tested a detailed investigation program.
- A definitive diagnosis was reached within 24 hours for 10 patients.
- The remaining 22 patients underwent the planned program, identifying a probable organic cause in 30 patients (94%).
- Identified causes typically fell into three categories: IHS, esophageal disease, and physiurgic conditions.
Impact:
- The investigation program is demonstrated to be employable and effective in diagnosing non-AMI chest pain.
- Suggests that the etiology of chest pain in non-AMI patients can often be categorized into IHS, esophageal disease, or physiurgic conditions.
- Highlights the importance of systematic investigation for non-AMI chest pain to identify underlying organic causes and potentially improve patient outcomes.
Abstract:
In half of the patients admitted with chest pain on suspicion of an acute myocardial infarction (AMI), this diagnosis is not confirmed (non-AMI). Both AMI and non-AMI patients have a mortality which exceeds the mortality of the background population in the years following discharge based on a high incidence of cardiac death. As a pilot investigation, a comprehensive investigation programme was tested in 32 consecutive non-AMI patients. The possible organic causes of acute chest pain were thus illustrated systematically in each individual patient. In ten of the patients, a definitive diagnosis was established within the first 24 hours of admission and no further investigation was thus performed. The remaining 22 patients participated in the planned investigation programme. In 30 of the patients (94%) a probable organic cause for the chest pain was found. This investigation demonstrates that the investigation programme is employable and it suggests that the cause of chest pain in non-AMI patients usually can be placed in one of the three main groups: 1) IHS, 2) oesophageal disease and 3) physiurgic conditions.