THE DIAGNOSES OF PATIENTS ADMITTED WITH ACUTE CHEST PAIN BUT WITHOUT MYOCARDIAL-INFARCTION

Objective The purpose of this study was to describe the frequencies of various diagnoses in patients admitted with acute chest pain, but wit hout acute myocardial infarction, and to evaluate a non-invasive scree ning programme for these patients. Patients A total of 204 consecutive non-acute myocardial infarction patients were included. Fifty-six had a definite diagnosis within 48 h, whereas 148 patients underwent an e xamination programme including pulmonary scintigraphy, echocardiograph y, exercise electrocardiography, myocardial scintigraphy, Holter monit oring, hyperventilation test, oesophago-gastro-duodenoscopy, 3 h monit oring of oesophageal pH, oesophageal manometry, Bernstein test, physic al examination of the chest wall and thoracic spine, bronchial histami ne provocation test and ultrasonic examination of the abdomen. Results According to predefined criteria, 186 patients (91%) had at least one diagnosis, 144 had one, whereas 39 had two, and three patients had th ree diagnoses. In 18 patients no diagnosis was obtained. The diagnoses belonged mainly to three groups: (1) ischaemic heart disease (n=64); (2) gastro-oesophageal diseases (n=85); (3) chest-wall syndromes (n=58 ). Less frequent diagnoses included pulmonary embolism, pleuritis/pneu monia, lung cancer, aortic stenosis, aortic aneurysm and herpes tester . Conclusions The high risk subset of a non-acute myocardial infarctio n population can be identified by means of a clinical evaluation and n on-invasive cardiac examinations. Among the remainder, pulmonary embol ism, gastro-oesophageal diseases and chest-wall syndromes should be pa id special attention. A careful physical examination of the chest wall and an upper endoscopy seems to be the most cost-beneficial examinati on to employ in this subset.