Al-Ani Mohammad, Winchester David E
From the *Department of Internal Medicine, and †Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida, Gainesville, FL.
Crit Pathw Cardiol. 2015 Sep;14(3):97-102. doi: 10.1097/HPC.0000000000000050.
When patients present to the emergency department with a complaint concerning for heart disease, this often becomes the primary focus of their evaluation. While patients with noncardiac causes of chest pain outnumber those with cardiac causes, noncardiac etiologies are frequently overlooked. We investigated symptoms and noncardiac conditions in a cohort of patients with chest pain at low risk of cardiac disease.
We analyzed data from a prospective registry of patients who were evaluated in our chest pain evaluation center. Registry participants completed standardized and validated instruments for depression (by Patient Health Questionnaire PHQ-9), anxiety (by Generalized Anxiety Disorder GAD-7), and Gastroesophageal Reflux Disorder (GERD; by GERD Symptom Frequency Questionnaire). Chest pain characteristics were recorded; severity was reported on a 10-point scale.
A total of 195 patients were included in the investigation. Using the instruments noted above, the prevalence of depression was 34%, anxiety was 30%, and GERD was 44%, each of at least moderate severity. 32.5% of patients had 2 or more conditions. The median for the severity of angina was 7/10 and the number of episodes over the preceding week was 2, respectively. Severity of angina was associated with PHQ-9 (r = 0.238; P < 0.001) and GAD-7 (r = 0.283; P < 0.001) scores. The number of angina episodes over the prior week correlated with GERD Symptom Frequency Questionnaire (r = 0.256; P < 0.001) and PHQ-9 (r = 0.175; P = 0.019) scores. No correlation was observed between any of the scores and body mass index, smoking tobacco, diabetes mellitus, hypertension, or hyperlipidemia.
In our cohort of low-risk acute chest pain patients, depression, anxiety, and GERD were common, substantial overlap was observed. The severity of these noncardiac causes of chest pain causes correlated with the self-reported severity and frequency of angina, but weakly. These conditions should be part of a comprehensive plan of care for chest pain management.
当患者因担心心脏病而前往急诊科就诊时，这往往会成为他们评估的主要重点。虽然因非心脏原因导致胸痛的患者数量超过因心脏原因导致胸痛的患者，但非心脏病因常常被忽视。我们调查了一组心脏病风险较低的胸痛患者的症状和非心脏疾病情况。
我们分析了在我们胸痛评估中心接受评估的患者的前瞻性登记数据。登记参与者完成了用于评估抑郁（通过患者健康问卷PHQ - 9）、焦虑（通过广泛性焦虑障碍GAD - 7）和胃食管反流病（GERD；通过GERD症状频率问卷）的标准化且经过验证的工具。记录胸痛特征；严重程度以10分制报告。
共有195名患者纳入调查。使用上述工具，抑郁的患病率为34%，焦虑为30%，GERD为44%，每种情况至少为中度严重程度。32.5%的患者有2种或更多情况。心绞痛严重程度的中位数为7/10，前一周发作次数为2次。心绞痛严重程度与PHQ - 9（r = 0.238；P < 0.001）和GAD - 7（r = 0.283；P < 0.001）评分相关。前一周心绞痛发作次数与GERD症状频率问卷（r = 0.256；P < 0.001）和PHQ - 9（r = 0.175；P = 0.019）评分相关。在任何评分与体重指数、吸烟、糖尿病、高血压或高脂血症之间均未观察到相关性。
在我们这组低风险急性胸痛患者中，抑郁、焦虑和GERD很常见，存在大量重叠情况。这些非心脏性胸痛病因的严重程度与自我报告的心绞痛严重程度和频率相关，但相关性较弱。这些情况应成为胸痛管理综合护理计划的一部分。
