Many patients with chest pain or chest tightness are misdiagnosed as coronary heart disease
The 47-year-old Mr. Wu was admitted to the attached hospital for chest pain, chest tightness and belching. He once attended the Beijing Anzhen Hospital. At that time, coronary heart disease was considered. However, no obvious abnormalities were found during dynamic electrocardiography and echocardiography, and coronary angiography was performed to exclude coronary heart disease. At Zhengzhou Fourth Hospital Affiliated Vascular Surgery and Gastroesophageal Reflux Center, the doctor gave Mr. Wu a 24-hour pH monitoring of the gastroscope and esophagus. He was diagnosed with gastroesophageal reflux disease and his symptoms were relieved by oral anti-acid drugs.
48-year-old Ms. Lee, due to pantothenic acid, heartburn with chest pain, premature beats to Zheng Dayi hospital. She had done a dynamic electrocardiogram showing ventricular premature beats for up to 2,204 times and had been treated with oral arrhythmia without any significant improvement. After Zheng’s hospital treatment at the Affiliated Hospital, after anti-reflux surgery, symptoms completely resolved and premature beats disappeared.
Patients with chest pain or chest tightness who have been treated with coronary artery disease are not rare. Dr. Ji Feng, deputy director of the Center, has encountered multiple cases of coronary artery stent placement. At most, five stents were placed in patients who did not alleviate the disease, and some even had coronary stents. Arterial bypass surgery has not improved.
Why does such misdiagnosis and mistreatment often occur? The reason for this is to talk about the nature of chest pain.
The difference between chest pain and angina caused by gastroesophageal reflux
The pain from any part of the neck to the lowest rib is collectively referred to as chest pain. Chest pain is related to the chest organs, ribs, or pectoral muscles, but it may also be caused by abdominal pain. But many people only have chest pain, first think of whether it is suffering from heart disease, and then go to the Department of Cardiology and frequent medical treatment, do ECG okay, do not trust, but also dynamic, and still nothing, still do not trust, do heart ultrasound or even coronary Arterial angiography is less than the determination of the Yellow River to die.
"Actually, chest pain caused by gastroesophageal reflux disease is not uncommon in clinical practice, but it has not attracted the attention of doctors. This type of pain varies from form to form, and sometimes it can radiate to the back, sometimes resembling angina attack." said Dr. Ji Feng There are four reasons why the two are often confused:
1. Similar pain sites: Visceral pain in the body can be perceived on the corresponding surface, or involved in other areas, showing pain in the distant areas. The heart and esophagus are innervated by autonomic nerves. The pain is mainly transmitted by sympathetic nerves. The pain fibers of the two are sometimes crossed in the central nervous system. Since the body suffering from superficial pain is more common than visceral pain, the central nervous system often misinterprets the pain information of the visceral afferent as superficial body tissue, and the chest is involved in pain.
2. Gastroesophageal reflux disease, gastric acid can stimulate the lower esophageal vagus nerve endings, through the visceral - vagal nerve reflex caused by coronary artery spasm, leading to myocardial ischemia and hypoxia, so there may be transient ST-T ECG changes (ST wave, T Waveform changes) or arrhythmia. Clinical diagnosis of gastroesophageal reflux disease mostly with typical reflux symptoms (ie, pantothenic acid, poststernal pain, heartburn, progressive dysphagia, etc.) as the main diagnostic basis.
3. Similar predisposing factors: Gastroesophageal reflux disease can occur after meals and during sleep, and can also be triggered by emotions. This is very similar to the cause of angina pectoris, especially spontaneous angina.
4. The response to nitroglycerin is similar: Chest pain can cause coronary spasm, myocardial ischemia and hypoxia caused by contraction, especially in patients with original coronary heart disease. The application of nitroglycerin can relieve temporary symptoms in some patients because nitric acid esters also relax the esophageal smooth muscle, relieve esophageal spasm while dilating the coronary arteries, increasing blood flow in the coronary circulation, and reducing venous return blood flow, thus alleviating Angina. Due to the improvement of symptoms and the lack of comprehensive understanding of the disease by clinicians, it is easy to cause misdiagnosis. However, the chest pain of gastroesophageal reflux disease was slow to respond to nitroglycerin, and the improvement of symptoms was not as obvious as angina.
Diagnosis: 24-hour esophageal pH monitoring and impedance check
“70% of non-cardiogenic chest pains may originate from the esophagus, most of which are caused by gastroesophageal reflux disease, and improper treatment is mostly caused by doctors who have not paid attention to this disease. Diagnosis of gastroesophageal reflux disease caused by chest pain mainly depends on 24-hour esophageal pH monitoring and impedance check, said Dr. Ji Feng.
For chest pain caused by gastroesophageal reflux, anti-acid drugs such as proton pump inhibitors or H2 receptor blockers, prokinetics drugs, and neutralizing acid drugs may be used alone or in combination. Those who are ineffective in medical treatment may also try anti-reflux surgery.
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