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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 can mimic myocardial ischemia but may stem from cervical disk disease. Prompt evaluation is crucial, and if life-threatening causes are excluded, consider herniated cervical disks for chest pain relief.
Area of Science:
- Emergency Medicine
- Neurology
- Cardiology
Background:
- Chest pain is a common emergency department presentation, often initially evaluated for myocardial ischemia.
- Established guidelines exist for managing chest pain, emphasizing ruling out life-threatening cardiac causes.
- Cervical disk disease is an under-recognized cause of chest pain.
Purpose of the Study:
- To highlight cervical disk disease as a potential cause of chest pain in adults.
- To present cases where herniated cervical disks mimicked cardiac ischemia.
- To encourage consideration of cervical disk disease after excluding emergent conditions.
Main Methods:
- Case report presentation of two patients with chest pain.
- Review of medical literature regarding cervical disk disease and chest pain.
- Clinical evaluation and diagnostic workup for chest pain and neurological symptoms.
Main Results:
- Two patients presented with symptoms suggestive of myocardial ischemia.
- Both patients were diagnosed with herniated cervical disks.
- Surgical repair of cervical disks resolved the patients' chest pain symptoms.
Conclusions:
- Cervical disk disease can present as chest pain mimicking myocardial ischemia.
- Herniated cervical disks should be considered in the differential diagnosis of chest pain once life-threatening conditions are ruled out.
- Surgical intervention for cervical disk disease can effectively alleviate associated chest pain.
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. We 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 shows 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.