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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Noncardiac chest pain remains an enigma that often defies precise diagnosis. Overlap of symptoms between esophageal and cardiac disorders may make differentiation extremely difficult. Exclusion of coronary artery disease is a key element of the management of noncardiac chest pain. Once this is accomplished, the physician can address the fears and concerns of the patient with confidence and often avoid any diagnostic studies of the esophagus. When diagnostic studies are performed, the physician should be mindful of their limitations. Since gastroesophageal reflux disease is probably the most common cause of esophageal chest pain, prompt recognition and treatment of this disorder may provide relief for many patients. Future studies should address the relationship between physiologic events in the esophagus and chest pain.
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PMID:Noncardiac chest pain. There's often an esophageal cause. 267 66

The pathogenesis of recurrent noncardiac chest pain remains an enigma. The literature suggests that it may be caused by a heightened state of visceral nociperception. Coronary atherosclerosis must first be excluded with a reasonable degree of certainty. The physician can then focus on reassuring the patient and continuing management, bearing in mind the caveat, first do no harm. Polypharmacy and hazardous procedures should be avoided. Aggressive acid suppression is helpful in patients with gastroesophageal reflux disease, and antidepressants have shown promise in otherwise unexplained cases of chest pain. Despite significant morbidity in patients with the disorder, the long-term prognosis is excellent.
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PMID:Noncardiac chest pain: where does it start? 896 12

This case report represents the difficulties in diagnosing brucellosis, which is an enigma with unusual cardiovascular complications. A 32-year-old Caucasian man with acute chest pain was examined at Sfax Hedi Chaker's Hospital. He had a night fever, although his cardiac examination was normal. Further laboratory analyses showed an elevated C-reactive protein of 20.8 mg/dL and troponine I of 1.469 IU/L. A cardiac MRI using delayed enhancement was then performed. The T2-weighted short-axis showed a subepicardial delaying enhancement of infero-lateral and the basal walls of the left ventricle. Accordingly, a diagnosis of Brucella-related myocarditis was made.
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PMID:Brucella myocarditis: a rare and life-threatening cardiac complication of brucellosis. 2250 47

Spontaneous coronary artery dissection (SCAD) is a rare entity. It has been described in various settings like pregnancy, collagen vascular diseases, cocaine abuse, heavy exercise, variant angina, eosinophilic arteritis, or fibro muscular dysplasia. It is also easy to miss a dissection during angiography, as the typical radiolucent lumen seen in coronary angiography may be absent in many cases. In this report, we describe the case of a 35-year-old female who presented with acute ST elevation myocardial infarction due to spontaneous coronary dissection. She had been having episodic chest pain for one year and had been seen by two different cardiologists but was thought to have non-cardiac symptoms. Even during the index hospitalization, she underwent coronary angiography three times before coronary dissection could be identified as the cause of her symptoms. She underwent coronary artery bypass graft surgery uneventfully. However, even after myocardial revascularization, she has had multiple episodes of chest pain requiring hospitalization. However, we have not been able to find a specific cause for it and the cause of her recurrent chest pain remains an enigma. This case highlights the problems, which arise while managing a case of SCAD. More research is needed to find the exact etiology and long-term prognosis of this condition.
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PMID:Recurrent chest pain after treatment of spontaneous coronary artery dissection: An enigma. 2699 21

Variant angina also called Prinzmetals angina is an enigma characterized by transient circadian symptoms of chest pain associated with ECG changes. The patient is symptom free with normal ECG and echo during symptom free periods. We present a case associated with transient ST-segment elevation with non critical lesion with normal FFR.
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PMID:Prinzmetals angina presenting with non critical lesion with normal FFR -to stent or not to stent. 2843 25