Noncardiac Chest Pain

Non-cardiac chest pain (retrosternal, pseudoanginous) is defined as a constricting sensation localized in the middle of the breastbone (sternum), which is not caused by ischemic heart disease or other cardiac pathology. The assumption that the pain is of esophageal origin, can be made only by the exclusion of the etiological factors related to the skeletal muscle of the chest wall, as well as other mediastinal structures.  Although in the general population such pain is usually related to the origin of the heart, this type of pain is often likely to be caused by pathological conditions in the esophagus, such as GERD, achalasia or esophageal motor disorders. Because of the similarities with the pain that originates from the heart, it can be defined as pseudoanginous.

Hypercontracted esophagus caused by reflux of acidic contents into the esophagus or a pronounced spasm in patients with achalasia or diffuse spasm is the basic etiological factor in the occurrence of diseases pseudoanginoznog within the esophagus. This type of pain is often triggered by acid reflux into the esophagus, with or without a feeling of heartburn at the same time. Due to the irregular muscle contractions of the esophagus body retrosternal pain is also very common in patients with achalasia and esophageal motor disorders, primarily diffuse spasm, when associated with swallowing difficulties. This type of pain can occur during the act of swallowing, food intake, but even without it, suddenly in his sleep when the patient wakes up. In patients with retrosternal pain caused by motor disorders of the esophagus, the feeling of pain is getting worse by introducing extremely cold or hot foods and liquids (ice water) with the expansion of the spinal column. Consensus in Montreal in 2006 Gastroesophageal reflux disease is considered to be far more common cause of pain pseudoanginoznog esophageal motor disorders of the esophagus.

This kind of pain is very reminiscent of the pain of angina pectoris and myocardial infarction. For example, in the United States, close to 30% of patients who are admitted to the hospital as an emergency with suspected myocardial infarction, in fact, have retrosternal pain caused by a pathological process in the esophagus. It is also proven that more than 30% coronarographic tests conducted for chest pain is normal or insignificant, and about 50% of patients in whom cardiac origin of the pain has been excluded, has proven esophageal motility disorder, usually as part of GERD. The broader population studies have estimated the incidence non-cardiac chest pain between 20 to 35%, with, as opposed to heartburn, a tendency to decrease in incidence in older population. Characteristics of non-cardiac chest pain of esophageal origin are: pain is often provoked by food intake, sometimes stops after taking antacids, occurs at night, there are prolonged periods of remission and is often associated with other esophageal symptoms. Taking nitroglycerin preparation may also eliminate non-cardiac chest pain of esophageal origin, but unlike angina pectoris, nitroglycerin has an delayed effect or only after 10 minutes. It is notable that as high as 80% of patients who are due to the non-cardiac esophageal pain referred for esophageal functional diagnostics, have symptoms of heartburn, regurgitation or dysphagia.

When there is suspicion of retrosternal pain caused by a pathological process in the esophagus, for the definitive diagnosis it is necessary to make an endoscopy of the upper digestive tract, as well as motility tests of the esophagus.

Details about the reasons for the emergence of retrostemal, pseudoangionous pain read under gastroesophageal reflux disease , achalasia and esophageal motor disorders.

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