Oesophageal dysfunction and ischaemic heart disease as origin of chest pain in non-infarction coronary care unit patients and patients with myocardial infarction.

Oesophageal dysfunction (OD), ischaemic heart disease (IHD) and their relation to chest pain were studied in two groups of patients. A group of 55 non-infarction coronary care unit patients were investigated within 6 months and at a three-year follow-up, and 52 male patients were studies within 6 months after an acute myocardial infarction. Oesophageal manometry, pH recording, acid perfusion test, ECG at rest and exercise, history by questionnaire and by interview were used as diagnostic tools. Non-infarction coronary care unit patients with unknown origin of their chest pain at discharge from hospital had a higher frequency of OD (58%) than patients with recent myocardial infarction (33%, p less than 0.05). In 7 of 55 (13%) non-infarction patients OD was regarded as the cause and in 17 (31%) IHD was regarded as the cause of pain on admission to the coronary care unit. OD was an uncommon cause of angina-like chest pain in patients with recent myocardial infarction (1 of 38 patients). Patients with OD had a higher frequency of oesophageally related questionnaire symptoms than patients with normal oesophageal function. For the differential diagnosis of chest pain a careful history is essential. Reproduction of the patient's chest pain during oesophageal acid perfusion test or exercise test offers additional valuable information.