Chest pain atypical

We examined the effects of selective activation of histamine Hj receptors on coronary hemodynamics in two groups patients with atypical chest pain and normal coronary arteries, and patients with vasospastic angina [48]. Selective Hj receptor stimulation was achieved by infusing histamine intravenously (0.5 pg/kg/min) for 5 min after pretreatment with cimetidine to antagonize the H2 receptors. Heart rate was kept constant (100 beats/min) by coronary sinus pacing. 

A 59-year-old woman with hemolytic-uremic syndrome and a recent history of atypical chest pain was given prophylactic desmopressin 0.4 micrograms/kg immediately before a renal biopsy (28). Within 30 minutes she developed chest pain and bradycardia due to myocardial infarction. 

Atypical chest pain is more common in females, The females are more likely to have chest pain at rest, or sleep, or with periods of mental stress, They are more likely to have neck and shoulder pains, Fatigue, dyspnea, and nausea with vomiting are often present (6). 

In the second scenario, the test result excludes a diagnosis this is referred to as a rule-out test. The actions resulting from excluding a diagnosis will invariably involve the evaluation or creation of another hypothesis. When a patient is admitted with atypical chest pain and acute myocardial infarction is suspected, the measurement of troponin maybe used to rule out (or rule in) acute myocardial necrosis. 

Patients after interventional procedure with no evidence of ischemia Patients who are not candidates for or do not wish interventional procedures for revascularization Assessment of atypical chest pain... 

Vrachliotis TG, Bis KG, Haidary A, Kosuri R, Balasubrama-niam M, Gallagher M, Raff G, Ross M, O Neil B, O Neill W (2007) Atypical chest pain coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography. Radiology 243 368-376... 

Fig. 15.1a-d. Dualsource CT coronary angiography in a 49-year-old man with a single episode of atypical chest pain. Scanning was performed with in the step-and-shoot mode (mean heart rate 66 bpm). Curved multiplanar reformations of the right coronary artery (a), left anterior descending artery (b), and the left circmnflex artery. (c,d see next page)... 

Fig. 15.2a-e. (continued) Retrospectively ECG-gated dualsource CT coronary angiography in a 67-year-old woman with tachycardia and recurrent atypical chest pain. The mean heart... 

Fig. 15.3a-c. (continued) Retrospectively ECG-gated dualsource CT coronary angiography in a 56-year-old man with recurrent atypical chest pain and an inconclusive stress test. The mean heart rate during scanning was 68 bpm. The vol-miie-rendered image (b) similarly demonstrates the site of the stenosis (arrow). Invasive CCA (c) confirms the findings from CT (arrow)... 

Patients with transient cardiac symptoms such as palpitations, dizziness, syncope, conhision, paroxysmal dyspnea, and atypical chest pain once foced an uphill battle for a diagnosis. Because transient symptoms rarely arise during scheduled health care visits, patients commonly had to be admit and monitored until the symptoms surfaced. 

Atypical symptoms include non-allergic asthma, chronic cough, hoarseness, pharyngitis, chest pain, and dental erosions. 

Patients presenting with atypical symptoms may require higher doses and longer treatment courses than patients with typical symptoms. These patients are best diagnosed with ambulatory pH testing or an empiric trial with a PPI.23 These tests can confirm reflux in patients who have persistent symptoms without evidence of mucosal damage by endoscopy.1 In patients presenting with non-cardiac chest pain, a short course (1 to 8 weeks) of omeprazole 20 mg twice daily has been advocated.23... 

Older individuals have decreased host defense mechanisms such as slowed gastric emptying and decreased saliva production. They may present with atypical symptoms such as chest pain, asthma, hoarseness, coughing, wheezing, or poor dentition. These patients often do not seek medical attention because they believe their symptoms are part of the normal aging process. 

Refer patients who present with atypical symptoms such as cough, non-allergic asthma, or chest pain to their physician for further diagnostic evaluation. 

Severe cardiac pain, chest tightness, sweating, breathlessness and nausea. Some patients may present with atypical features including indigestion, pleuritic chest pain or dyspnoea. 

Figure 3.21 (A) ECG with a quite negative T wave in V1-V2 to V5, with extension to I and VL corresponding to a critical lesion in the proximal part of left anterior descending coronary artery that practically normalises during a chest pain crisis (B). This corresponds to an atypical pattern of STE-ACS (see Figure 8.3B). The normalisation of this...

In Table 4.3 the most frequent causes of ST-segment elevation, aside from IHD (typical and atypical ACS), are shown. At the time of making the differential diagnosis in clinical practice, out of all these different entities the possibility of a pericarditis or an early phase acute myopericarditis (Figures 4.48 and 4.49) should be kept in mind. These also cause chest pain that may complicate the diagnosis. 

The term acute coronary syndrome (ACS) encompasses all the clinical situations with acute myocardial ischaemia expressed by chest pain, discomfort or equivalent, which appears suddenly at rest (de novo) or has increased with regard to prior anginal (in crescendo angina). All this leads the patient to seek urgent medical care. However, occasionally the patient may underestimate the symptoms or the physician may not interpret them properly. In addition, the ACS may occur with no anginal pain, or the pain may be atypical or may present other... 

The diagnosis of non-ischaemic chest pain is made on the basis of its characteristics (atypical localisation, with no radiation, non-oppressive and with no vegetative symptoms) and other circumstances (age, lack of risk factors, prior history, concomitant findings, complementary tests, etc.) (Figure 7.1). Occasionally, the diagnosis of non-ischaemic chest pain is clear, as it occurs with radicular pain (patient... 

Transient dyskinesia of the mid- and basal part of LV Recently, transient dyskinesia of the mid-and basal part of LV in patients presenting striking ST-segment deviations sometimes has been described (Hurst et al, 2006). Catecholamine discharge and stroke are frequently associated. Often the patient presents chest pain. Although this atypical ACS seems related to high catecholamine release, it is difficult to understand why dyskinesia of all basal part of left ventricle is present because this area does not correspond to any specific myocardial territory perfusion (see p. 267). 

X syndrome Sometimes patients with X syndrome may present chest pain at rest that may be considered an atypical ACS (see p. 298). 

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