Constant J
Department of Internal Medicine, State University of New York, Buffalo 14216.
Keio J Med. 1990 Sep;39(3):187-92. doi: 10.2302/kjm.39.187.
The term "atypical chest pain" is a waste-basket term that leads physicians to send any patient with chest pain to coronary angiography. In order to avoid this term, we must learn to distinguish atypical angina from nonanginal chest pain before angiography is considered in order to avoid unnecessary invasive procedures. A chest pain is very likely nonanginal if its duration is over 30 minutes or less than 5 seconds, it increases with inspiration, can be brought on with one movement of the trunk or arm, can be brought on by local fingers pressure, or bending forward, or it can be relieved immediately on lying down. There are also many presumptive signs of nonanginal chest pain such as localization with one finger, radiation to the nuchal area, an inframammary primary site, a pain that reaches maximum at the onset, or relief within a few seconds of swallowing food. Cervical root compression pain and esophageal spasm are the greatest mimics of angina since they can both be relieved by nitroglycerin but they have several features which help to rule out angina.
“非典型胸痛”这一术语是个“大杂烩”术语，它导致医生将任何有胸痛症状的患者都送去做冠状动脉造影。为避免使用该术语，我们必须学会在考虑进行造影检查之前，将非典型心绞痛与非心绞痛性胸痛区分开来，以避免不必要的侵入性检查。如果胸痛持续时间超过30分钟或少于5秒、随吸气加重、可因躯干或手臂的一次动作诱发、可因手指局部按压或向前弯腰诱发，或者躺下后可立即缓解，那么这种胸痛很可能是非心绞痛性的。非心绞痛性胸痛还有许多推测性体征，比如用一根手指就能定位、向颈部放射、乳房下的原发部位、疼痛在发作时达到最大值，或者在吞咽食物几秒钟内缓解。颈神经根受压性疼痛和食管痉挛是最容易与心绞痛混淆的情况，因为它们都可被硝酸甘油缓解，但它们有一些有助于排除心绞痛的特征。
