The Prevalence of Rheumatologic Disorders in Patients with Chest Pain and Angiographically Normal Coronary Arteries

Abstract

The purpose of this study was to determine the prevalence of musculoskeletal disorders in patients with chest pain and angiographically normal coronary arteries. The authors studied 40 consecutive patients with chest pain presenting at an Internal Medicine Clinic who had undergone coronary angiography and were found to have < 30% stenosis of all major coronary arteries. Patients with any known noncardiac cause of chest pain were excluded from the study. Each patient underwent a complete rheumatologic examination with x-rays and blood tests when indicated. The diagnosis of fibromyalgia was based on the presence of at least eight paired tender points. The diagnosis of costochondritis was made when palpation of the costal cartilages elicited tenderness. In the normal coronary artery group, 30% of the patients had fibromyalgia and 10% had costochondritis. In the control group of 40 patients with coronary artery disease, only 1 patient had fibromyalgia and none had costochondritis (P < 0.04). Other rheumatologic disorders were uncommon, with no statistical difference between the two groups. The authors conclude that many patients with chest pain and angiographically normal coronary arteries suffer from rheumatologic disorders with fibromyalgia being the most common.

The head says yes but the heart says no: what is non-cardiac chest pain and how is it managed?

“…The pain from carpal tunnel syndrome sometimes radiates to the left side of the chest. There may be localised tenderness50 although, surprisingly, this did not differentiate our patients with and without proven coronary disease 68…”

“…Between 5% and 30%13 23 49 are thought to have a musculoskeletal origin for chest pain including cervical spondylosis, or fibromyalgia50 A thoracic respiratory pattern sometimes associated with overt hyperpnoea (‘hyperventilation’) is commonly associated with NCCP. This may occur spontaneously or be precipitated by psychophysiological processes such as panic or stress arousal.…”

Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life

“…In accordance with previous studies, they were found in 15%. Among them chest wall syndromes (chostochondritis) (Wise et al, 1992) and fibromyalgia (Mukerji et al, 1995) were observed. In these patients, typical chest pain can be evoked by palpation in tender areas such as the sternal and xiphoid area, left costosternal junctions, and left anterior chest wall (Wise et al, 1992), but poor inter‐observer consistency for clinical orthopaedic tests needs to be considered when assigning a differential diagnosis.…”

Evaluation of Noncardiac Chest Pain

“…Как правило, они довольно интенсивные, колющие или жгучие, иррадиируют по ходу ребер, в лопатку, верхнюю конечность на стороне поражения [64; 65; 66]. Кроме того, фибромиалгии или фиброз отмечались у 30% пациентов с некардиогенной торакалгией [67].…”