Adolph Esther, Ince Hüseyin, Chatterjee Tushar, Nienaber Christoph A
Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin, Medizinische Fakultät der Universität Rostock, Rostock.
Herz. 2004 Sep;29(6):582-8. doi: 10.1007/s00059-004-2599-8.
In patients with an acute chest pain syndrome the primary requirement is to diagnose or exclude acute myocardial ischemia or myocardial infarction. However, only 30% of patients admitted and evaluated for chest pain ultimately reveal the diagnosis of acute coronary syndrome.Traditionally, the initial evaluation of patients presenting with chest discomfort or pain to an emergency department or any general practice involves the triad of history, physical examination, and ECG and chest film evaluation. With the diagnostic routine of bedside enzymatic tests for cardiac biomarkers, it has become easier to identify acute coronary syndromes, but at the same time more compelling to pinpoint other differential diagnoses, once coronary syndromes are excluded. When a cardiac origin of any non-suggestive chest pain syndrome has been excluded, a broad spectrum of other causes for noncardiac chest pain needs to be evaluated. Potential underlying disorders are listed in this overview and grouped according to pathoanatomic origin into aortic, respiratory, and gastroesophageal disorders, musculoskeletal pathology, and somatization disorders. This article reviews both symptoms and diagnostic pathways in patients with noncardiac chest pain, and eventually offers a rational strategy for an efficacious workup of a wide spectrum of important differential diagnoses.
对于急性胸痛综合征患者，首要任务是诊断或排除急性心肌缺血或心肌梗死。然而，因胸痛入院并接受评估的患者中，最终确诊为急性冠脉综合征的仅占30%。传统上，对于因胸部不适或疼痛前往急诊科或任何普通诊所就诊的患者，初始评估包括病史、体格检查以及心电图和胸部X光片评估。随着床边心脏生物标志物酶促检测诊断程序的出现，识别急性冠脉综合征变得更加容易，但与此同时，一旦排除冠脉综合征，明确其他鉴别诊断也变得更加迫切。当排除任何无提示意义的胸痛综合征的心脏病因后，需要评估非心脏性胸痛的多种其他病因。本综述列出了潜在的基础疾病，并根据病理解剖学来源分为主动脉疾病、呼吸系统疾病、胃食管疾病、肌肉骨骼病变和躯体化障碍。本文回顾了非心脏性胸痛患者的症状和诊断途径，并最终为广泛的重要鉴别诊断提供了一种有效的检查合理策略。
