Severe chest pain during stress dobutamine echocardiogram in patient with patent epicardial coronary arteries

Background: Coronary computed tomography (CT) may improve the early triage of patients with acute chest pain in the emergency department (ED). The aim of this study was to compare the presence and extent of coronary atherosclerotic plaque as detected by coronary CT in patients with and without acute coronary syndromes (ACS). Methods: The study was designed as a prospective, observational cohort study in patients with acute chest pain but negative cardiac biomarkers and no diagnostic ECG changes, admitted to rule out myocardial ischemia. All patients underwent coronary CT prior to hospital admission. The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of (1) coronary segments with plaque, or (2) major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was adjudicated by a review committee using established AHA criteria; subjects with history of CAD (stent placement, bypass) were excluded. Results : Among 368 patients with acute chest pain (mean age 53±12 years, 61% male) 31 patients were determined to have ACS (8%). None of the 183 subjects without plaque (50%) had an ACS. Among the remaining 185 subjects (mean age 58.0±11.5 years, 68% male) in whom coronary plaque was detected, patients with ACS had a significantly more plaque (7.2±3.7 vs. 4.2±3.4, p<0.0001 segments) as compared to subjects without ACS. Similar results were seen for calcified plaque and non-calcified plaque (6.5±3.7 vs. 3.6±3.5 segments, p<0.0001; and 3.6±3.2 vs. 1.8±2.2 segments, p<0.0001, respectively). In addition, the rate of ACS increased with the number of major coronary arteries with plaque (1-vessel: 6.8%, 2-vessels: 10.6%, 3 vessels: 30.8%, and 4-vessels: 25%; p<0.01). In contrast, the ratio of non-calcified to calcified plaque was not different between patients with and without ACS (0.68±0.6 vs. 0.54±0.72, p=0.31). Conclusions: The extent of coronary plaque differs between subjects with and without ACS among patients presenting with acute chest pain. Detailed assessment of the extent and composition of coronary plaque may be helpful to assess risk of ACS among patients with acute chest pain but inconclusive initial ED evaluation.

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Chest pain with unobstructed coronary arteries and cardiac syndrome X

British Journal of Cardiac Nursing ◽

10.12968/bjca.2012.7.7.310 ◽

2012 ◽

Vol 7 (7) ◽

pp. 310-315 ◽

Cited By ~ 1

Author(s):

Carolyn M Webb ◽

Peter Collins

Keyword(s):

Chest Pain ◽

Coronary Arteries ◽

Syndrome X ◽

Cardiac Syndrome X ◽

Cardiac Syndrome

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The Prevalence of Rheumatologic Disorders in Patients with Chest Pain and Angiographically Normal Coronary Arteries

Angiology ◽

10.1177/000331979504600510 ◽

1995 ◽

Vol 46 (5) ◽

pp. 425-430 ◽

Cited By ~ 21

Author(s):

Basanti Mukerji ◽

Vaskar Mukerji ◽

Martin A. Alpert ◽

Rajesh Selukar

Keyword(s):

Chest Pain ◽

Coronary Arteries ◽

Normal Coronary Arteries

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Severe chest pain with mid-ventricular obstruction in a patient with hyperthyroidism

Yeungnam University Journal of Medicine ◽

10.12701/yujm.2017.34.1.128 ◽

2017 ◽

Vol 34 (1) ◽

pp. 128-131

Author(s):

Jong Ho Nam ◽

Jang Won Son ◽

Geu Ru Hong

Keyword(s):

Chest Pain ◽

Severe Chest Pain

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Abstract 129: Chest Pain Characteristics of Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA) in Comparison to Myocardial Infarction With Coronary Artery Disease (MI-CAD)

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.129 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Sivabaskari Pasupathy ◽

Rosanna Tavella ◽

Margaret Arstall ◽

Derek Chew ◽

Matthew Worthley ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Coronary Arteries ◽

Public Hospitals ◽

Arm Pain ◽

Retrosternal Pain ◽

Pain Characteristics ◽

Artery Disease

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is being increasingly recognized with the frequent use of angiography following Acute Myocardial Infarction (AMI); yet there is little evaluation of these patients in the literature. The current study is a prospective, contemporary analysis of clinical features and chest pain characteristics between patients with MINOCA and Myocardial Infarction with coronary artery disease (MI-CAD). Methods: All consecutive patients undergoing coronary angiography for AMI (as per the Third Universal AMI Definition) in South Australian public hospitals from January 2012 - December 2013 were included. Data was captured by Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR ® CathPCI ® Registry. The AMI patients were classified as MI-CAD or MINOCA on the basis of the presence or absence of a significant stenosis (≥50%) on angiography. Results: From 3,431 angiography procedures undertaken for AMI, 359 (11%) were classified as MINOCA. MINOCA patients were younger (59 ± 15 vs. 64 ± 13, p <0.01) and more likely to be female (60% vs. 26%, p<0.01), with age adjusted analysis revealing less cardiovascular risk factors in MINOCA compared to MICAD: current smoker (21% vs. 35%, p< 0.01), hypertension (56% vs. 65%, p<0.01), dyslipidaemia (46% vs. 61%, p<0.01), and diabetes (20% vs. 32%, p<0.01). Analysis of presenting chest pain characteristics showed no significant differences between MICAD and MINOCA for the presence of retrosternal pain (81% vs. 82%, p>0.05,) or shoulder pain (27% vs. 26%, p>0.05) respectively, however MINOCA patients were less likely to experience arm pain (33% vs. 40%, p<0.01). In regards to precipitating factors, emotional stress was more common (14% vs. 5%, p<0.001) and exertion related chest pain was less common (27% vs. 40%, p<0.001) in MINOCA patients. Quality of pain for MINOCA and MICAD was similar with the most frequent descriptors being burning (11% vs. 9%, p>0.05), sharp 21% vs. 23%, p>0.05) and tightness (41% vs. 44%, p>0.05). In addition, there were no significant differences observed between groups in relieving factors and duration of chest pain Conclusions: In contemporary cardiology practice, MINOCA presentation is more common than previously appreciated, with younger women frequently implicated. Delineating a MINOCA patient from MICAD on the basis of chest pain characteristics is not feasible.

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