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[Atypical chest pain: study by the hydrochloric acid provocation test]
B Salis Graciela1, J C Chiocca, J Marcarián
1Servicio de Gastroenterología, Hospital Nacional Profesor Alejandro Posadas, Provincia de Buenos Aires, Argentina.
Insights
Gastroenterological issues, not coronary artery disease, often cause chest pain in patients. Esophageal manometry revealed abnormal esophageal motility in most patients, suggesting a non-cardiac origin for their chest pain.
Area of Science:
- Gastroenterology
- Cardiology
- Physiology
Context:
- Chest pain is a common symptom with diverse origins, often necessitating differentiation between cardiac and non-cardiac causes.
- Patients with chest pain frequently undergo cardiological evaluation, including coronary arteriography, to rule out coronary artery disease.
- Gastrointestinal disorders, particularly esophageal dysfunction, are increasingly recognized as significant contributors to chest pain presentations.
Purpose:
- To investigate the origin of chest pain (CP) in patients with both normal and pathological coronary arteries.
- To evaluate the role of esophageal manometry (EM) and provocative testing in diagnosing the cause of chest pain.
- To correlate esophageal motility patterns and responses to provocative tests with coronary arteriogram findings.
Summary:
- This study utilized esophageal manometry, electrocardiography (ECG), and heart rate/pressure product (RPP) monitoring in patients experiencing chest pain.
- Abnormal basal esophageal manometry findings, including increased wave pressure and aperistaltic waves, were observed in 61.9% of patients.
- A positive response to the hydrochloric acid provocative test occurred in 14.2% of patients, with the heart rate/RPP relationship being the only statistically significant finding.
Impact:
- Highlights the significant prevalence of esophageal motility disorders in patients presenting with chest pain, even those with normal coronary arteries.
- Suggests that esophageal manometry is a valuable tool for identifying non-cardiac causes of chest pain.
- Recommends further research combining 24-hour esophageal manometry and pH monitoring with more sensitive provocative tests like edrophonium chloride for comprehensive diagnosis.
Abstract:
Evaluation by means of gastroenterological and cardiological methods. The purpose of this paper was to study the origin of chest pain (CP) in patients with normal and pathological coronary arteries as characterized by coronary arteriogram (CA). Sixteen normal control individuals (X 27 years -7 females and 9 males) were studied by means of esophageal manometry (EM) with a 3 way catheter perfused by a low compliance capillary system. Twenty-one patients with chest pain were studied and divided according to coronary arteriogram in normal (NC) and pathological arteries (PC). They were simultaneously studied by means of EM, heart rate/pressure product (RPP), and 12 lead ECG monitoring. After a basal period they were given a Bernstein's provocative chest pain test, and after each of its stages we determined in a simultaneous fashion CP, EM, ECG and RPP. In 61.9% of the patients abnormal basal EM was found. It was characterized by increase in HPZ, duration, propagation velocity and pressure of the peristaltic waves: as well as an increase in the percentage of aperistaltic waves. In 14.2% of the patients the Hydrochloric provocative test was positive. The only statistically significant datum was the heart rate/RPP relationship. We conclude that in future studies it would be of interest to combine 24 hour monitoring EM and pH as well as a more sensitive provocation test such as edrophonium chloride.