[Musculoskeletal-related chest pain]. / Muskuloskeletal bedingter Thoraxschmerz.

BACKGROUND: Approximately 10-50% of chest pains are caused by musculoskeletal disorders. The association is twice as frequent in primary care as in emergency admissions. AIM: This article provides an overview of the most important musculoskeletal causes of chest pain and on the diagnostics and therapy. METHODS: A selective search and analysis of the literature related to the topic of musculoskeletal causes of chest pain were carried out. RESULTS AND CONCLUSION: Non-inflammatory diseases, such as costochondritis and fibromyalgia are frequent causes of chest pain. Inflammatory diseases, such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus are much less common but are more severe conditions and therefore have to be diagnosed and treated. The diagnostics and treatment often necessitate interdisciplinary approaches. Chest pain caused by musculoskeletal diseases always represents a diagnosis by exclusion of other severe diseases of the heart, lungs and stomach. Physiotherapeutic and physical treatment measures are particularly important, including manual therapy, transcutaneous electrical stimulation and stabilization exercises, especially for functional myofascial disorders.

Azacitidine-Induced Pericarditis: A Case Series.

STUDY OBJECTIVE: To describe three cases of pericarditis probably related to azacitidine administration in a span of 3 years at our center. DESIGN: Case series. SETTING: Comprehensive cancer center within a large, academic medical center. PATIENTS: Three patients with high-grade myelodysplastic syndrome or acute myeloid leukemia who received azacitidine. INTERVENTION: None. MEASUREMENTS: None. MAIN RESULTS: Patient 1 presented with pericarditis after cycle 2 of azacitidine, patient 3 presented 3 weeks after completing cycle 5, and patient 2 presented during cycle 1. All patients were treated symptomatically and responded to corticosteroids. None of the patients were re-challenged with hypomethylating agents. Use of the Naranjo adverse drug reaction probability scale indicated a probable adverse drug reaction (score of 6) for patients 1 and 3 and a possible adverse drug reaction (score of 3) for patient 2. CONCLUSION: With the exclusion of other common causes of pericarditis, we believe it is likely that azacitidine was responsible for the findings in our patients. Providers caring for patients receiving hypomethylating agents should consider this potential adverse drug reaction in the setting of unexplained chest pain or other clinical signs consistent with cardiotoxicity.

Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial.

BACKGROUND: Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking. METHODS/DESIGN: We present an ongoing trial on the potential usefulness of chiropractic diagnosis and treatment in patients dismissed from an acute chest pain clinic without a diagnosis of acute coronary syndrome. The aims are to determine the proportion of patients in whom chest pain may be of musculoskeletal rather than cardiac origin and to investigate the decision process of a chiropractor in diagnosing these patients; further, to examine whether chiropractic treatment can reduce pain and improve physical function when compared to advice directed towards promoting self-management, and, finally, to estimate the cost-effectiveness of these procedures. This study will include 300 patients discharged from a university hospital acute chest pain clinic without a diagnosis of acute coronary syndrome or any other obvious cardiac or non-cardiac disease. After completion of the clinic's standard cardiovascular diagnostic procedures, trial patients will be examined according to a standardized protocol including a) a self-report questionnaire; b) a semi-structured interview; c) a general health examination; and d) a specific manual examination of the muscles and joints of the neck, thoracic spine, and thorax in order to determine whether the pain is likely to be of musculoskeletal origin. To describe the patients status with regards to ischemic heart disease, and to compare and indirectly validate the musculoskeletal diagnosis, myocardial perfusion scintigraphy is performed in all patients 2-4 weeks following discharge. Descriptive statistics including parametric and non-parametric methods will be applied in order to compare patients with and without musculoskeletal chest pain in relation to their scintigraphic findings. The decision making process of the chiropractor will be elucidated and reconstructed using the CART method. Out of the 300 patients 120 intended patients with suspected musculoskeletal chest pain will be randomized into one of two groups: a) a course of chiropractic treatment (therapy group) of up to ten treatment sessions focusing on high velocity, low amplitude manipulation of the cervical and thoracic spine, mobilisation, and soft tissue techniques. b) Advice promoting self-management and individual instructions focusing on posture and muscle stretch (advice group). Outcome measures are pain, physical function, overall health, self-perceived treatment effect, and cost-effectiveness. DISCUSSION: This study may potentially demonstrate that a chiropractor is able to identify a subset of patients suffering from chest pain predominantly of musculoskeletal origin among patients discharged from an acute chest pain clinic with no apparent cardiac condition. Furthermore knowledge about the benefits of manual treatment of patients with musculoskeletal chest pain will inform clinical decision and policy development in relation to clinical practice. TRIAL REGISTRATION: NCT00462241 and NCT00373828.

Positive shifts in the perceived meaning of cardiac pain following a psychoeducation program for chronic stable angina.

This study examined the meaning of cardiac pain for chronic stable angina (CSA) patients who participated in a standardized angina psychoeducation program. The patients documented what angina meant to them at sessions 1 and 6 of a 6-week standardized psychoeducation program aimed at enhancing CSA self-management. At session 1, angina was described as a major negative life change characterized by fear, frustration, limitations, and anger. At session 6, angina signified a broad and ongoing pain problem requiring continual self-management in order to maximize quality of life. The findings suggest that the perceived meaning of angina as a burdensome and debilitating life change shifts, during psychoeducation, to one of angina as a broad pain problem requiring ongoing self-management in order to preserve life goals and functioning. How such perceptual shifts in the meaning of cardiac pain might contribute to the overall effectiveness of psychoedcuation warrants further investigation.

[Analysis of the causes of postoperative chest or/and abdomen colic in benign prostatic hyperplasia].

OBJECTIVE: To analyze the causes of chest or/and abdomen colic with in 1 week after prostatectomy and transurethral resection of the prostate (TURP). METHODS: Retrospective studies were made on 120 cases of benign prostatic hyperplasia (BPH) with postoperative colic in the chest or/and abdomen from October 2001 to October 2002, 35 (Group A) treated by prostatectomy and the other 85 (Group B) by TURP. RESULTS: In sequence of frequency, the causes of the postoperative chest or/and abdomen colic were bladder spasm, catheter block, acute gastroenteritis, angina and acute myocardial infarction. CONCLUSION: The causes of chest or/and abdomen colic after prostatectomy are multiple. If the causes are timely established and corresponding measures immediately taken, its complications can be minimized.

Effects of oral magnesium therapy on exercise tolerance, exercise-induced chest pain, and quality of life in patients with coronary artery disease.

Previous studies have demonstrated that magnesium supplementation improves endothelial function in patients with coronary artery disease (CAD). However, the impact on clinical outcomes, such as exercise-induced chest pain, exercise tolerance, and quality of life, has not been established. In a multicenter, multinational, prospective, randomized, double-blind and placebo-controlled trial, 187 patients with CAD (151 men, 36 women; mean +/- SD age 63 +/- 10 years, range 42 to 83) were randomized to receive either oral magnesium 15 mmol twice daily (Magnosolv-Granulat, total magnesium 365 mg provided as magnesium citrate) (n = 94) or placebo (n = 93) for 6 months. Symptom-limited exercise testing (Bruce protocol) and responses given on quality-of-life questionnaires were the outcomes measured. Magnesium therapy significantly increased intracellular magnesium levels ([Mg]i) in a substudy of 106 patients at 6 months compared with placebo (35.5 +/- 3.7 vs 32.6 +/- 2.9 mEq/L, p = 0.0151). Magnesium treatment significantly increased exercise duration time compared with placebo (8.7 +/- 2.1 vs 7.8 +/- 2.9 minutes, p = 0.0075), and lessened exercise-induced chest pain (8% vs 21%, p = 0.0237). Quality-of-life parameters significantly improved in the magnesium group. These findings suggest that oral magnesium supplementation in patients with CAD for 6 months results in a significant improvement in exercise tolerance, exercise-induced chest pain, and quality of life, suggesting a potential mechanism whereby magnesium could beneficially alter outcomes in patients with CAD.

[Study on anti +Gx respiratory maneuver and its training method].

Objective. To study the anti +Gx respiratory maneuver and its training method. Method. Seven young male subjects undertook the anti +Gx respiratory maneuver training. Their +Gx tolerances were examined on human centrifuge before and after training. The change of respiratory type, breath rate, electrocardiogram, heart rate, arterial oxygen saturation (SaO2), subjective symptom and vision were real-time monitored during the +Gx tolerance examination. Result. Compared with pre-training, the +Gx tolerance increased after training (P<0.05). Dyspnea and chest pain disappeared or obviously lightened and the magnitude of decrease of SaO2 decreased significantly (P<0.05). Conclusion. The above results suggested that the anti +Gx respiratory maneuver can effectively eliminate or alleviate dyspnea and chest pain induced by +Gx stress and increase human +Gx tolerance.

Correlation of ambulatory 24-hour esophageal pH monitoring results with symptom improvement in patients with noncardiac chest pain due to gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) accounts for up to 60% of patients with noncardiac chest pain (NCCP). Twenty-four-hour esophageal pH monitoring has been considered the most sensitive test for identifying acid reflux as the probable cause for chest pain. It is unclear if there is a correlation between the degree of esophageal acid exposure as determined by 24-hour esophageal pH monitoring and symptom improvement during a short course of high-dose omeprazole (the omeprazole test) in patients with NCCP due to GERD. Twenty-three patients with GERD-related NCCP were studied. All patients were referred by a cardiologist and evaluated by upper endoscopy and 24-hour esophageal pH monitoring. Diagnosis of GERD was defined by one or both tests being abnormal. Subsequently, patients underwent baseline symptom intensity assessment during 1 week off therapy followed by 1 week on therapy with high-dose omeprazole (40 mg A.M. and 20 mg P.M.). There was a statistically significant correlation between the esophageal acid exposure by 24-hour esophageal pH monitoring and the change in symptom intensity score after treatment. However, there was no significant correlation between the pH values and symptom intensity score during baseline or during the omeprazole test. In patients with GERD-related NCCP undergoing the omeprazole test, 24-hour esophageal pH monitoring has a therapeutic predictive value in addition to its diagnostic merit. Patients with greater esophageal acid exposure appear to have a greater response to antireflux treatment.

Hyperventilation syndrome and the assessment of treatment for functional cardiac symptoms.

Three methods of breathing retraining (guided breathing retraining, guided breathing retraining with physiologic monitoring of thoracic and abdominal movement plus peripheral temperature, and guided breathing retraining with physiologic monitoring of thoracic and abdominal movement, peripheral temperature and end-tidal carbon dioxide) were compared with a no-treatment control group to determine the effectiveness of breathing retraining on modifying respiratory physiology and reducing functional cardiac symptoms in subjects with signs associated with hyperventilation syndrome. Of 41 subjects studied, 16 were diagnosed with mitral valve prolapse. Results demonstrated that all 3 methods of breathing retraining were equally effective in modifying respiratory physiology and reducing the frequency of functional cardiac symptoms. Results determined that respiratory rate and subject's perception that training had generalized were the best predictors of treatment success. Furthermore, it was found that subjects with mitral valve prolapse responded as well to treatment as did those without prolapse.

Use of transcutaneous electrical nerve stimulation in the control of postoperative chest pain after cardiac surgery.

The effect of continuous transcutaneous electrical nerve stimulation (TENS) on postoperative pain following median sternotomy was evaluated in 89 patients with severe chest pain who underwent cardiac surgery in a prospective, randomized, blinded trial. Pain was assessed by visual analog pain scores before and during treatment in each group. In the active TENS group, 79% of the patients were completely free of chest pain during rest at the end of 180 minutes (P less than 0.001). Among the remaining patients with TENS, 16% had slight pain not needing narcotic analgesics and 5% still had chest pain requiring narcotics. In the control group in which inactive TENS was used, the intensity of pain was reduced in 44% of the patients at the end of 90 minutes (P less than 0.001). However, this early placebo effect was noted to diminish with time and at the end of 180 minutes, 80% of the patients complained of severe chest pain and needed narcotics. These data suggest that TENS can be effective in controlling postoperative chest pain due to median sternotomy after cardiac surgery and its continuous application in the early postoperative period can reduce the need for narcotics.