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Diagnosis and prognosis of chest pain with normal coronary arteriograms
Insights
Patients with normal coronary arteriograms often remain symptomatic with cardiac-like chest pain. Esophageal spasm is a common cause, not coronary artery spasm, in these individuals.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Medicine
Background:
- Patients investigated for angina with normal coronary arteriograms represent a significant clinical challenge.
- Persistent symptoms and diagnostic uncertainty are common in this patient cohort.
- Understanding the etiology of residual symptoms is crucial for effective patient management.
Purpose of the Study:
- To evaluate the long-term prognosis and symptom persistence in patients with normal coronary arteriograms initially diagnosed with suspected angina.
- To identify the underlying causes of persistent cardiac-like chest pain in this population.
- To differentiate between cardiac and non-cardiac etiologies of chest pain.
Main Methods:
- Retrospective review of 98 patients with normal coronary arteriograms initially investigated for angina.
- Assessment of symptom status and re-evaluation of pain etiology at an average three-year follow-up.
- Diagnostic investigations including coronary artery spasm assessment and esophageal function tests.
Main Results:
- Excellent life expectancy was observed in the patient group.
- A high percentage (76%) remained symptomatic at follow-up, with 41% experiencing cardiac-like pain.
- Coronary artery spasm and myocardial ischemia were rare; esophageal spasm was identified as a frequent cause of pain.
Conclusions:
- Patients with normal coronary arteriograms have a good prognosis but often experience persistent symptoms.
- Esophageal spasm is a common and often overlooked cause of cardiac-like chest pain in patients with initially normal coronary arteries.
- Further investigation into non-cardiac causes like esophageal dysfunction is warranted for symptomatic patients with normal coronary arteriograms.
Abstract:
Ninety-eight patients previously investigated for suspected angina but shown to have normal coronary arteriograms were reviewed. The prognosis for like expectancy was excellent but 76% were still symptomatic after average follow up of three years. 41% of those re-evaluated were still thought to be describing cardiac-like pain. Full re-investigation showed coronary artery spasm or other causes of myocardial ischemia to be rare whereas oesophageal spasm was a common cause of the pain.