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Herniated cervical disk presenting as ischemic chest pain
L C Mitchell1, R W Schafermeyer
1Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232.
Insights
Chest pain in adults may stem from cervical disk disease, not just heart issues. Promptly rule out life-threatening conditions before considering herniated cervical disks as a cause.
Area of Science:
- Emergency Medicine
- Neurosurgery
- Cardiology
Background:
- Chest pain is a common emergency department presentation, with myocardial ischemia being the primary concern.
- Established guidelines exist for evaluating chest pain, emphasizing the exclusion of life-threatening cardiac causes.
- Cervical disk disease is an underrecognized potential cause of chest pain.
Observation:
- Two cases are presented where patients exhibited symptoms suggestive of cardiac ischemia.
- Diagnostic workup revealed herniated cervical disks as the underlying cause in both instances.
- Surgical intervention for cervical disk herniation resulted in complete symptom resolution.
Findings:
- Cervical disk herniation can mimic cardiac ischemia symptoms.
- This diagnosis was well-documented in medical literature mid-20th century but is less frequently discussed currently.
- Herniated cervical disks should be considered in the differential diagnosis of chest pain after life-threatening causes are excluded.
Implications:
- Emergency physicians should broaden their differential diagnosis for chest pain to include cervical disk disease.
- Increased awareness may lead to earlier diagnosis and appropriate treatment for patients with non-cardiac chest pain.
- Revisiting historical medical literature can uncover valuable, underutilized diagnostic insights.
Abstract:
Myocardial ischemia must be the first concern of every emergency physician in evaluating chest pain in the adult patient. Any suspicion of myocardial ischemia must be promptly evaluated and admitted. The American College of Emergency Physicians has recently published a standards document on the care of chest pain in the adult patient. The emergency physician must be familiar with this document. Once myocardial ischemia and other life-threatening causes are ruled out, one can consider that cervical disk disease may be the cause of chest pain. The authors present two cases of patients who presented to the Emergency Department with signs and symptoms consistent with cardiac ischemia. Both patients were found to have herniated cervical disks. Subsequent surgical repair completely relieved their symptoms. Evaluation of the literature reveals that this entity was well described from 1950 to the 1960s. Most recent discussions do not mention disk herniation as even an infrequent cause of chest pain. If there is no life-threatening disease present, one should consider cervical disk disease.