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Chest pain

Causes
Clinical features
Investigations
Therapy
Prognosis
Investigations

Consider performing oesophageal tests c after coronary artery disease has been excluded. d Treat the results cautiously - they may suffer from observer bias d and may not indicate the true cause c

Why?

  • Gastroesophageal reflux or motility disorder is common in both patients with and without coronary artery disease. c
  • Neither abnormal ambulatory oesophageal pressure and pH monitoring, nor relief with nitrates clearly exclude coronary artery disease c
  • There are wide differences in patients reporting chest pain during oesophageal edrophonium testing depending on the clinician performing the test. These differences may be due to the manner of the clinician. d

Abnormal oesophageal manometry makes coronary artery disease less likely but cannot rule it out

Patient Target Disorder and
Reference Standard		 Diagnostic Test LR+
(95% CI) 		Post-test Probability LR-
(95% CI) 		Post-test Probability
recurrent exertional chest pain c
(pre-test probability: 40%) 		coronary artery disease
(coronary angiography) 		normal oesophageal manometry 1.6
(1.2 to 2.1) 		52% 0.22
(0.056 to 0.83) 		13%

 

Expiry date: June 2003
Levels of Evidence used in grading these guides

Author   CM   Ball
Reviewer   S   Straus
CAT Writers   CJ   Wotton , CM   Ball , N   Shenker , RS   Phillips