Non-infarction coronary care unit patients. A three-year follow-up with special reference to oesophageal dysfunction and ischaemic heart disease as origin of chest pain.

Among 55 consecutive coronary care unit (CCU) patients with chest pain of unknown origin at discharge from hospital, signs of oesophageal dysfunction (OD) were found in 58% and signs of ischaemic heart disease (IHD) in 35% within 2-6 months. At a three-year follow-up, signs of OD were found in 62% and signs of IHD in 28%. Forty-six patients (84%) had experienced a pain similar to that which caused the CCU admission (i.e. the CCU chest pain). OD was regarded as the cause of the CCU chest pain in seven patients (13%) and as a possible cause in another nine (16%). IHD was regarded as the cause of the CCU chest pain in 17 patients (31%), four of whom had died from acute myocardial infarction during the follow-up period. All ten patients who developed coronary events, such as myocardial infarction or progressive angina pectoris, during the follow-up period had an ischaemic ECG reaction at exercise test 2-6 months after discharge from the CCU. IHD was found to be the predominant disease in terms of severity of symptoms and prognosis and was also recorded as the most common single cause of the CCU chest pain. Since OD was common and even caused severe chest pain in some patients, oesophageal origin should be considered in the differential diagnosis of chest pain in non-infarction CCU patients.