Chest pain is a usual reason for ho...

Chest pain is a usual reason for hospital admission. In principally patients with chest pain, acute coronary artery disease (CAD) is the major pertain to Nitrates often are used in extremity treatment of acute chest pain, unless relief with nitrates is an uncertain diagnostic and prognostic sign. Because nitro-glycerin can relieve symptoms of noncardiac chest pain, including esophageal spasm, its value as a tool in the diagnosis of ischemic heart disease is questionable. Henrikson and associates mode of actioned a prospective study to determine the usefulness of chest pain replication to nitroglycerin as an indicator of ischemic coronary disease.

Patients who had documented chest pain while beneath medical supervision were given nitroglycerin. A chest pain answer to the first dose of nitroglycerin was defined as a 50 percent or greater decrease in pain intensity within five minutes of nitroglycerin administration. The port of active CAD was determined for all participants. Active CAD was defined as elevated troponin flats abnormal angiography, a positive stres proof or diagnosis at the time of hospital admission that was confirmed through a study cardiologist. Follow-up telephone calls were made to all participants approximately four month after hospitalization to determine clinical status.

Of the total thought sample of 459 patients, 181 patients had relief of chest pain with nitroglycerin. In patients with chest pain that likely was caused on active CAD, 35 percent had pain relief with nitroglycerin. Nitroglycerin also reduc chest pain in 41 percent of the patients without active CAD. the two sensitivity and specificity of chest pain relief through nitroglycerin as a predictor of active CAD were soft in the study group as a whole and in the subgroup Chest pain relief also did not predict outcomes

The authors decide that in an emergency setting, chest pain relief with nitro-glycerin lacks diagnostic or prognostic value for acute CAD. These findings possibly could be applied to chiefly outpatient settings.

In an editorial in the same journal, Gibbons questions the external validity of the findings by the agency of noting that response to nitroglycerin has different physiologies in patients with acute chest pain and in those with chronic stable angina who have myocardial ischemia. He points on the outside that the evidence supporting the predictive value of replication to nitroglycerin in the chronic setting is able Gibbons concludes that the close attention findings may be legitimate in the acute setting, if it were not that that nitrate responsive-ness is a useful diagnostic and prognostic tool in patients with chronic stable chest pain.

Henrikson CA, et al. Chest pain relief by way of nitroglycerin does not predict active coronary artery disease. Ann Intern M December 16 2003;139:979-86 and Gibbons RJ Nitro-glycerin: should we still ask? [Editorial]. Ann Intern M December 16 2003;139:1036-7

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group