[Sinoatrial block caused by gastroesophageal reflux. The role of simultaneous 24 hr. esophageal pH-metry and Holter-ECG in the differential diagnosis of angina pectoris].

UNLABELLED

The authors report on a 61-year-old female patient, who has suffered from recurrent angina-like chest pain for 30 years. The patient's complaints became intolerable, in spite of therapy with nitroglycerin, H2 receptor blockers and sedative medication. The echocardiography, the ECG exercise testing and Thallium scintigraphy were normal, the upper gastrointestinal endoscopy did not prove oesophagitis either macroscopically or microscopically. The simultaneous 24-hr Holter ECG monitoring and esophageal pH-metry demonstrated pathological acid gastro-oesophageal reflux and frequent sinoatrial blocks (Mobitz I) in painful periods. After monotherapy with proton pump inhibitor (omeprazole) the patient became complaint-free. Repeated combined 24-hr oesophageal pH-metry and Holter ECG monitoring indicated nonpathological acid reflux and insignificant number of sinoatrial blocks. During the course of 19 months the patient was asymptomatic. The acid pump inhibitor was stopped for a 10 day-period, while the chest pain returned. The combined 24-hr Holter ECG and esophageal pH-metry proved pathological acid gastro-oesophageal reflux and frequent sinoatrial blocks during chest pain period. After treatment with acid pump inhibitor the patient became asymptomatic again.

CONCLUSIONS

1. The acid gastro-oesophageal reflux may be a provocative factor of sinoatrial blocks and it can be influenced by proton pump inhibitor successfully. 2. Simultaneous 24-hr oesophageal pH-metry and Holter ECG monitoring can be contribute to the differentiation among causes of atypical chest pain.