title: Cervicothoracic angina identified by case history and palpation findings in patients with stable angina pectoris.
abstract: OBJECTIVE
  To investigate the decision-making process of an experienced chiropractor in diagnosing noncardiac musculoskeletal chest pain of cervicothoracic angina in patients with stable angina pectoris, based on patient history and clinical examination. Secondly, to examine the possibility of obtaining an objective diagnostic rule tool for the identification of cervicothoracic angina and to validate the diagnosis of this disorder.
  
  
  METHODS
  A nonrandomized prospective trial was performed at a university hospital. A total of 516 of 972 consecutive patients referred for coronary angiography because of known or suspected angina pectoris were asked to participate in the study. Of these, 275 gave informed consent to a standardized manual examination of their spine and thorax. Diagnoses of an experienced chiropractor on cervicothoracic angina patients. Myocardial perfusion imaging and coronary angiography were used for validation. A set of candidate variables from patient history and clinical examination were tested for their role in the decision-making process.
  
  
  RESULTS
  Eighteen percent of the patients were diagnosed with cervicothoracic angina. Of these, 80% had normal myocardial perfusion compared to 50% of cervicothoracic angina-negative patients. The main determinants of the decision-making process could be identified.
  
  
  CONCLUSIONS
  An experienced chiropractor could identify a subset of patients with angina pectoris as having cervicothoracic angina. Systematic manual palpation of the spine and thorax could be used as part of the clinical examination together with basic cardiological variables to screen patients with chest pain allowing for improvements in referral patterns for specialist opinion or angiography.
authors.affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. h.wulff@nikkb.dk
authors.forename: Henrik Wulff
authors.initials: HW
authors.lastname: Christensen
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.forename: Anthony
authors.initials: A
authors.lastname: Gichangi
authors.forename: Claus
authors.initials: C
authors.lastname: Manniche
authors.forename: Torben
authors.initials: T
authors.lastname: Haghfelt
authors.forename: Poul Flemming
authors.initials: PF
authors.lastname: Høilund-Carlsen
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications*; D002574:Cervical Vertebrae; D002684:Chiropractic / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013909:Thorax