In two-thirds of cases, chest pain is caused by internal organs or muscle problems in the back or ribs and has nothing to do with the heart.
The body’s perceptions are not always necessarily correct. When it comes to chest pain, not all chest pain is due to heart problems. That was the question answered by a team of researchers at the recent Best of Imaging 2020, a conference organized by the European Society of Cardiology and held virtually Dec. 11-12.
During the conference, the researchers presented a study on chest pain unrelated to heart problems. This pain is one of the most common causes of emergency room visits.
Patients are not always reassured
92 patients between the ages of 51 and 63 who visited an emergency department physician were used for the study. To make sure the pain they were experiencing was not related to a heart problem, all underwent a CT scan of the coronary arteries, which showed no damage to the heart. “Previous studies have shown that these patients don’t trust their test results and still think they have heart disease,” says Isabel Krohn, a radiologist at Haukeland University Hospital in Bergen, Norway.
In 2018 alone, 600 people came to the emergency room at Haukeland University Hospital with chest pain. Of those, one-third – or 200 people – had healthy arteries, meaning there were no calcifications or narrowing of the artery lumen, according to the scan results.
Similar studies at other hospitals showed that two-thirds of patients had non-cardiac chest pain. Most often, this pain has multiple causes originating from organs and muscles adjacent to the chest. The most common causes of pain include digestive disorders or gastric reflux, musculoskeletal conditions such as back pain or muscle pain between the ribs, or psychological problems such as panic attacks and anxiety.
An educational effort
“I noticed that several patients who came to us for a diagnosis of their chest pain had already had a coronary CT scan and other cardiac tests that showed no signs of coronary artery disease,” says Isabel Krohn. To convince the 92 patients that their pain had nothing to do with the heart, the doctors had to explain their complaints three times.
In the first part, the participants received detailed information about the scan that had been performed, both verbally and through an easy to understand written brochure. This included the various reasons for chest pain, the low likelihood of inaccurate results, and the very low risk of a future heart attack if the scans showed healthy arteries. In a second step, participants were able to view their own images of the calcium score to visually reinforce the brochure’s message. Finally, the radiologist told the patients that their results were normal.
“I explained the information in the brochure and the pictures and subtly asked questions to see if the patient understood. This helped personalize the interaction. The sessions lasted between five and fifteen minutes, depending on the level of explanation needed by each patient. I think discussing the results with the patients immediately after the test also helps them to accept the results,” Isabel Krohn points out. This type of teaching is likely to become increasingly common as a means of improving health knowledge in the coming years.