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 without acute myocardial infarction, and to evaluate a non-invasive screening 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 examination programme including pulmonary scintigraphy, echocardiography, exercise electrocardiography, myocardial scintigraphy, Holter monitoring, hyperventilation test, oesophago-gastro-duodenoscopy, 3 h monitoring of oesophageal pH, oesophageal manometry, Bernstein test, physical examination of the chest wall and thoracic spine, bronchial histamine 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 three 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/pneumonia, lung cancer, aortic stenosis, aortic aneurysm and herpes zoster.
CONCLUSIONS: The high risk subset of a non-acute myocardial infarction population can be identified by means of a clinical evaluation and non-invasive cardiac examinations. Among the remainder, pulmonary embolism, gastro-oesophageal diseases and chest-wall syndromes should be paid special attention. A careful physical examination of the chest wall and upper endoscopy seems to be the most cost-beneficial examination to employ in this subset.