非心脏性胸痛

非心脏性胸痛 (noncardiac chest pain,NCP)或不能解释的胸痛 (unexplained chest pain,UCP)是指在适当的评估之后 ,与心脏无关的复发性心绞痛样的或胸骨下的胸痛。 U CP这个术语可能更恰当些 ,因为即使在冠状血管造影正常的病人 ,偶而也发现有心肌缺血的证据 (即微血管的心绞痛或 X综合征 )。 1892年 Osler首先提出食管可能是发作性胸痛的原因。2 3%～ 80 % U CP的病人有食管的异常。U CP的长期的死亡率低 ,10年约 <1% [1 ]。1　病理生理学食管引起胸痛的确切机制未明。可能的主要机制是涉及食管内不同感受器的刺激作用 ,然后通过在…     

Musculoskeletal chest wall pain

The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment.     

评价急诊胸痛评分预测急诊胸痛患者风险的价值

目的 评价急诊胸痛评分预测急诊胸痛患者,尤其是急性冠状动脉综合征(acute coronary syndrome,ACS)患者风险的价值。方法 根据急诊胸痛评分(Emergency Department Assessment of Chest Pain Score,EDACS)计算出分值,对于＜16分者视为低危患者,对于≥16分者视为高危患者。比较心源性胸痛和非心源性胸痛患者、ACS和非ACS患者、急性心肌梗死和不稳定性心绞痛患者的EDACS分值,并分别计算EDACS的敏感度与特异度。结果 心源性胸痛患者EDACS分值明显高于非心源性胸痛,ACS患者分值明显高于非ACS患者,急性心肌梗死患者分值与心绞痛患者分值近似。以EDACS≥16分诊断心源性胸痛为标准, EDACS的敏感度为71.77%,特异度为87.62%。以EDACS≥16分诊断ACS为标准,EDACS敏感度为72.92%,特异度为83.98%。以EDACS≥16分诊断急性心肌梗死为标准,EDACS的敏感度为71.02%,特异度为25.31%。结论 EDACS能较好地鉴别心源性胸痛患者,尤其是ACS患者,但是不能区分急性心肌梗死和不稳定性心绞痛患者。     

胸痛与非胸痛患者CT冠状动脉成像的对照研究

目的 探讨64层螺旋CT冠状动脉成像(CTCA)对胸痛患者冠状动脉病变的临床应用价值。 方法 将2012年2月-2014年4月在马鞍山市人民医院行CTCA检查的105例患者按主诉分为胸痛组和非胸痛组,回顾性比较分析2组患者一般资料、冠状动脉斑块阳性病例数、斑块性质、节段数目和管腔狭窄程度的差异。 结果 胸痛组56例,冠状动脉斑块阳性者45例,共176节段,其中非钙化斑块77节段、钙化斑块64节段、混合斑块35节段,0级狭窄患者11例、1级狭窄33例、2级狭窄6例、3级狭窄6例;非胸痛组49例,冠状动脉斑块阳性者23例,共69节段,其中非钙化斑块44节段、钙化斑块17节段、混合斑块8节段,0级狭窄患者26例、1级狭窄18例、2级狭窄1例、3级狭窄4例。2组性别比较差异无统计学意义(χ2=3.26,P=0.07);2组平均年龄比较差异无统计学意义(t=0.64,P=0.52);胸痛组冠状动脉斑块阳性病例数显著高于非胸痛组(χ2=12.79,P<0.001);2组斑块性质差异有统计学意义(χ2=8.03,P=0.02);2组冠状动脉斑块节段数目对比差异有统计学意义(Z=-3.71,P<0.001);2组管腔狭窄程度比较差异有统计学意义(Z=-3.33,P<0.001)。 结论 CTCA检查显示,胸痛患者冠状动脉斑块阳性例数和节段数目、管腔狭窄程度均高于非胸痛患者,斑块性质构成也有所不同,因此CTCA对于胸痛患者冠状动脉病变具有重要的临床应用价值。      

Managing acute enigmatic chest pain.

The author comments on the report by Dr. Akbar Panju and associates (see pages 541 to 547 of this issue) on patient outcomes associated with a discharge diagnosis of "chest pain not yet diagnosed." Acute chest pain without evidence of cardiac involvement presents a diagnostic challenge for the clinician, particularly in the present climate of cost containment. Esophageal disorders and psychiatric conditions appear to be the most prevalent causes of noncardiac chest pain. Although screening by means of electrocardiography and cardiac enzyme testing may rule out acute ischemia, and other tests may clearly point to a gastrointestinal cause, it is possible for cardiac and gastrointestinal problems to present simultaneously. Understanding and managing persistent chest pain even after a diagnosis has been made continues to challenge clinicians and researchers, and further progress in this area will depend on multidisciplinary collaboration.     

心理行为因素与胸痛的发作

中国医学论坛报1999年9月23日报告了由情绪激动后突发胸痛、胸闷、气急以及血压升高心动过速的病例,心电图有缺血性改变,先后经多位心血管内科专家门诊诊治无效,最后由一位研究心身疾病的心内科医师确定为急性焦虑症惊恐发作,改用抗焦虑治疗,10d后胸痛缓解,心动过速和高血压消失.这个病例首发症状是胸痛,并有心电图异常改变和高血压、心动过速,但是按心血管疾病的治疗方案,并不能解决问题,原因在于胸痛等心血管症状是其表面现象,其本质是由于情绪应激所促发,只有矫正了情绪应激,才能彻底解决问题.     

An unusual etiology of chest pain

Absence of right coronary artery is a rare coronary anomaly that may present with myocardial ischemia. This is a case report of a 49-year-old female with chest pain and positive stress test. Coronary angiogram revealed absence of right coronary artery with normal left coronary system.     

胸痛的急诊思维

目的浅要探析胸痛急诊处理思维模式。方法选取2010年5月—2011年8月急诊科收治的以胸痛为主诉就诊的184例患者的临床资料,总结分析。结果 184例患者中,心源性胸痛125例,占67.9%,其中心绞痛93例,心肌梗死19例,心肌炎10例,心包炎3例。非心源性胸痛59例,占32.1%,支气管肺炎21例,食管源性疾病16例,肋间神经痛4例,肋间软骨炎4例,带状疱疹5例,胃癌2例,主动脉夹层动脉瘤2例,胸膜炎1例。心源性胸痛发病高于非心源性胸痛发病率,对比差异有统计学意义（P〈0.05）。结论胸痛患者急诊时应先做出辨证诊断然后给予合适治疗,以最大限度的降低漏诊误诊率。辨证、清晰、有效的思维模式是患者预后的重要保障。     

以胸痛为主诉的支气管哮喘26例临床分析

目的 探讨以胸痛为主要表现的支气管哮喘（简称哮喘）的临床特点与诊断要点。方法 在不明原因的胸痛患者当中通过支气管激发试验筛查哮喘患者，通过诊断性治疗确立哮喘诊断，分析患者的临床特点。结果 62例不明原因的胸痛患者中，经支气管激发试验、诊断性治疗并排除其他疾病，26例诊断为支气管哮喘。患者均以程度不等的胸痛为主要表现，22例（84．62％）同时有轻微的胸闷、气紧和咳嗽等症状，15例胸痛发作的诱因与哮喘常见诱因相同。规范治疗后所有患者胸痛症状均完全或部分缓解。结论 胸痛是哮喘的一种特殊临床表现，以胸痛为主诉的哮喘在临床上易被误诊，应通过支气管激发试验，结合治疗反应并排除其他疾病进一步确诊。     

急诊胸痛患者心血管不良事件预测中急性胸痛评分的应用准确性分析

目的 探讨急诊胸痛患者心血管不良事件预测中急性胸痛评分的应用准确性.方法 选取2017年1月至2019年12月因急性胸痛在本院就诊的300例患者作为研究对象,对其临床资料进行回顾性研究,比较不同状态患者急性胸痛评分情况.Logistic回归分析预后心血管不良事件的风险因素,分析急性胸痛评分对预后心血管不良事件的预测情况...     

Fatal leptospirosis presenting as musculoskeletal chest pain

After holidaying in Vanuatu, a 24-year-old man presented with pleuritic chest pain and chest wall tenderness thought to be musculoskeletal in origin. He developed fatal acute renal failure, jaundice, respiratory failure, myocarditis and rhabdomyolysis. Subsequent serological results showed a rise in serum titre of antibodies to Leptospira grippotyphosa, from 1 : 50 to 1 : 800, consistent with acute infection.     

Cost burden of non-specific chest pain admissions

Background

Non-cardiac aetiologies are common among patients presenting with chest pain.

Aim

To determine the cost of non-specific chest pain admissions to a tertiary referral, teaching hospital.

Methods

Thrombolysis in myocardial infarction risk (TIMI) risk score, lengths of stay (LOS), investigations and diagnoses were recorded for patients admitted with chest pain. Non-specific chest pain was defined as chest pain where cardiac, pulmonary and gastroesophageal aetiologies were excluded. Costs of admissions were calculated.

Results

Of 80 patients, 34 (43 %) and 22 (28 %) were diagnosed with non-specific chest pain and acute coronary syndrome, respectively. Non-specific chest pain admissions had a mean age of 54 (11; 35–74) years, LOS of 3.8 (2.6; 1–11) days and TIMI risk score of 1.4 (1.5; 0–5). Acute coronary syndrome admissions had a mean age of 67 (14; 43–94) years, LOS of 7.7 (4.3; 2–16) days and TIMI risk score of 3.1 (1.2; 0–5). The mean cost per non-specific chest pain admission was €3,729 (2,378; 1,034–10,468), or 48 % of the mean cost per acute coronary syndrome admission of €7,667 (4,279; 1,963–16,071). Bed day costs account for >90 % of overall costs. Only 7 % of patients were weekend discharges. The mean interval to exercise stress test was 2.7(1.5; 1–7) days.

Conclusions

The mean costs of admission and LOS for patients with non-specific chest pain are significant. Extrapolating findings, annual national cost is estimated at approximately €71 million for this cohort, with 73,000 bed days consumed nationally. Delays from admission to tests and low percentage of weekend discharges prolong LOS