Levine P R, Mascette A M
Department of Medicine, Walter Reed Army Medical Center, Washington, DC.
South Med J. 1989 May;82(5):580-5, 591. doi: 10.1097/00007611-198905000-00010.
We prospectively evaluated 62 adults referred for coronary arteriography, using a systematic physical examination protocol to identify musculoskeletal sources of chest pain. In seven patients (11%) the chest pain was reproduced on physical examination; six of them ultimately had a diagnosis of nonanginal chest pain made by their cardiologist, based on history and data from noninvasive and coronary arteriographic studies. Five had normal coronary arteriograms. These patients described their pain in terms often associated with true angina. Musculoskeletal tenderness that did not reproduce the pain was common and was unrelated to coronary artery disease. Demonstration of musculoskeletal tenderness that reproduces chest pain, when combined with noninvasive findings suggesting low probability of coronary artery disease, may be useful in decreasing the incidence of unnecessary invasive cardiac evaluation, and appropriately directing initial therapy.
我们前瞻性地评估了62名因冠状动脉造影而被转诊的成年人，采用系统的体格检查方案来确定胸痛的肌肉骨骼来源。在7名患者（11%）中，体格检查时再现了胸痛；其中6名最终被其心脏病专家根据病史以及无创和冠状动脉造影研究数据诊断为非心绞痛性胸痛。5名患者冠状动脉造影正常。这些患者描述的疼痛症状常与真正的心绞痛相关。未再现疼痛的肌肉骨骼压痛很常见，且与冠状动脉疾病无关。当再现胸痛的肌肉骨骼压痛与提示冠状动脉疾病可能性较低的无创检查结果相结合时，可能有助于降低不必要的侵入性心脏评估的发生率，并合理指导初始治疗。
