Chest pain in daily practice: occurrence, causes and management.

TitreChest pain in daily practice: occurrence, causes and management.
Publication TypeJournal Article
Year of Publication2008
AuthorsVerdon, F, Herzig, L, Burnand, B, Bischoff, T, Pécoud, A, Junod, M, Mühlemann, N, Favrat, B
Corporate AuthorsGMIRG
JournalSwiss Med Wkly
Volume138
Issue23-24
Pagination340-7
Date Published2008 Jun 14
DOI
ISSN1424-7860
Mots-clésAdult, Aged, Chest Pain, Female, Humans, Incidence, Male, Middle Aged, Primary Health Care, Prospective Studies
Abstract

QUESTIONS UNDER STUDY: We assessed the occurrence and aetiology of chest pain in primary care practice. These features differ between primary and emergency care settings, where most previous studies have been performed.

METHODS: 59 GPs in western Switzerland recorded all consecutive cases presenting with chest pain. Clinical characteristics, laboratory tests and other investigations as well as the diagnoses remaining after 12 months of follow-up were systematically registered.

RESULTS: Among 24,620 patients examined during a total duration of 300 weeks of observation, 672 (2.7%) presented with chest pain (52% female, mean age 55 +/- 19(SD)). Most cases, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the reason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pain (including chest wall syndrome) (49%), cardiovascular (16%), psychogenic (11%), respiratory (10%), digestive (8%), miscellaneous (2%) and without diagnosis (3%). The three most prevalent diseases were: chest wall syndrome (43%), coronary artery disease (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were uncommon (1.8%). Potentially serious conditions including cardiac, respiratory and neoplasic diseases accounted for 20% of cases. A large number of laboratory tests (42%), referral to a specialist (16%) or hospitalisation (5%) were performed. Twentyfive patients died during follow-up, of which twelve were for a reason directly associated with thoracic pain [cancer (7) and cardiac causes (5)].

CONCLUSIONS: Thoracic pain was present in 2.7% of primary care consultations. Chest wall syndrome pain was the main aetiology. Cardio - vascular emergencies were uncommon. However chest pain deserves full consideration because of the occurrence of potentially serious conditions.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/18561039?dopt=Abstract

Alternate JournalSwiss Med Wkly
Citation Key / SERVAL ID2653
PubMed ID18561039

                         

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