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Sunday, December 11, 2011

Chest Pain from Non-Cardiac Origin (NCCP)

Posted by Prahallad Panda on 6:55 PM Comments

Chest pain can arise from any of the structures in the chest wall and from organs inside the chest. But, it is very much better to suspect chest pain to be of cardiac (Heart) origin, until unless proved otherwise.

Non-cardiac chest pain (NCCP) is a term used to describe chest pain that resembles heart pain (also called angina) in patients apparently free from heart disease. The pain typically is felt behind the breast bone (sternum) and is described as oppressive, squeezing or pressure-like.

NCCP is a very common problem of international proportions. Population studies have shown that in the United States as many as 69 million patients (23% of the population) suffer from NCCP. Similar figures have been descri
English: Heart and lungs
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bed in Australia (33%), Spain (8-28%), Argentina (24%), and South China (21%).

The pain may travel to the neck, left arm, upper abdomen or the back (the spine). It may be precipitated by food intake. It lasts variable periods of time and it is not unusual for it to last hours.

Patients may also complain of heartburn (a burning feeling behind the breast bone) or fluid regurgitation (a sensation of stomach juices coming back toward the chest and even to the mouth frequently with a bitter or sour taste).
Many times patients present to the emergency rooms thinking it to be pain of heart attack. They usually undergo cardiac studies like ECG, laboratory tests, stress test and even coronary angiography (Where dye is injected into the heart vessels).
After excluding heart disease from the tests the patients receive the diagnosis of NCCP, leading the physician to examine other causes for this chest pain.
The heart and the esophagus are located in the chest cavity (thorax) in close proximity. They receive very similar nerve supply. Thus, brain cannot distinguish pain arising from either organ, as it travels through the same nerve sensory fibers.
Several studies have shown that approximately 60% or more of patients with NCCP suffer from esophageal pain (mostly due to acid reflux commonly referred to as Gastroesophageal Reflux Disease (GERD).

Therefore, patients having chest pain who had have negative cardiac evaluation are frequently subjected to evaluation of esophagus as source of their chest pain.
1. NCCP from esophageal origin can be due to;

2. Non-esophageal Causes of NCCP can be from;

  • Musculoskeletal conditions of the chest wall,
  • Spine,
  • Lungs and pleural illness (the layers of tissue that cover the lungs) and
  • Pericardial conditions (the layer of tissue that protects the heart).
  • Digestive disorders such as ulcers,
  • Gallbladder diseases,
  • Pancreatic diseases and
  • Tumors.

3. Pain from stress and emotional disorders, which is diagnosed after exclusion of all organic causes.
Physical examination many times can give a diagnosis, if it originates from pleura, lungs and pericardium. After special investigations like, x-rays examination of spine and chest, and ultrasonogram etc.

Treatment usually commences according to the cause, but pending final diagnosis a PPI (Proton Pump Inhibitor) is usually prescribed with a provisional diagnosis of pain from esophageal origin. If, organic diseases are excluded psychological evaluation becomes necessary.
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