title: Chest pain in emergency department patients: if the pain is relieved by nitroglycerin, is it more likely to be cardiac chest pain?
abstract: BACKGROUND
  It is often believed that chest pain relieved by nitroglycerin is indicative of coronary artery disease origin.
  
  
  OBJECTIVE
  To determine if relief of chest pain with nitroglycerin can be used as a diagnostic test to help differentiate cardiac chest pain and non-cardiac chest pain.
  
  
  METHODS
  Prospective observational cohort study with a 4-week follow-up of patients enrolled.
  
  
  METHODS
  Academic tertiary care hospital, with 60,000 visits/year.
  
  
  METHODS
  Adult patients presenting to the emergency department with active chest pain who received nitroglycerin and were admitted for chest pain.
  
  
  METHODS
  Patients with acute myocardial infarction diagnosed after obtaining an ECG, patients whose chest pain could not be quantified, those for whom no cardiac work-up was done, or those who received emergent cardiac catheterization.
  
  
  RESULTS
  270 patients were enrolled. Nitroglycerin relieved chest pain in 66% of the subjects. The diagnostic sensitivity of nitroglycerin to determine cardiac chest pain was 72% (64%-80%), and the specificity was 37% (34%-41%). The positive likelihood ratio for having coronary artery disease if nitroglycerin relieved chest pain was 1.1 (0.96-1.34). Telephone follow-up at 4 weeks was performed, with a 95% follow-up rate.
  
  
  CONCLUSIONS
  Relief of chest pain with nitroglycerin is not a reliable diagnostic test and does not distinguish between cardiac and non-cardiac chest pain.
authors.affiliation: Loma Linda University Medical Center, Loma Linda, California 92354, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Steele
authors.forename: Timothy
authors.initials: T
authors.lastname: McNaughton
authors.forename: Melissa
authors.initials: M
authors.lastname: McConahy
authors.forename: John
authors.initials: J
authors.lastname: Lam
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin