Musculoskeletal chest pain in patients with "angina": a prospective study

We prospectively evaluated 62 adults referred for coronary arteriography, using a systematic physical examination protocol to identify musculoskeletal sources of chest pain. In seven patients (11%) the chest pain was reproduced on physical examination; six of them ultimately had a diagnosis of nonanginal chest pain made by their cardiologist, based on history and data from noninvasive and coronary arteriographic studies. Five had normal coronary arteriograms. These patients described their pain in terms often associated with true angina. Musculoskeletal tenderness that did not reproduce the pain was common and was unrelated to coronary artery disease. Demonstration of musculoskeletal tenderness that reproduces chest pain, when combined with noninvasive findings suggesting low probability of coronary artery disease, may be useful in decreasing the incidence of unnecessary invasive cardiac evaluation, and appropriately directing initial therapy.