Non-cardiac Chest Pain may Not be Benign

Health Care, Medicine Comments Off

Patients discharged with non cardiac chest pain may not always b with low risk as a new study shows a worrying one-year mortality rate of around 4% in this group, which is higher in patients with a previous psychiatric hospitalization. Around one-third of the deaths were cardiovascular, suggesting that a fairly substantial number of patients with heart disease are being missed when presenting to hospitals with chest pain. The study is published in European Heart Journal on December 1, 2011 by Dr Michelle Gillies from University of Glasgow, Scotland.

One should do a thorough review of the diagnostic parameters that lead to a diagnosis of non cardiac chest pain. In patients with negative high-sensitivity troponin and stress tests and in whom a specific non cardiac cause of the chest pain has not been identified, the use of N-terminal pro-brain natriuretic peptide (NT-pro BNP) or the measurement of unbound free fatty acids may be considered, which have shown high negative predictive abilities.

Given the known link between psychiatric and cardiovascular diseases, the best time for intensive cardiac evaluation would be at the initial psychiatric hospitalization or diagnosis of psychiatric illness, rather than at hospitalization for chest pain.