Chest pain in emergency department patients: if the pain is relieved by nitroglycerin, is it more likely to be cardiac chest pain?
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.
Steele
Robert
R
Loma Linda University Medical Center, Loma Linda, California 92354, USA.
McNaughton
Timothy
T
McConahy
Melissa
M
Lam
John
J
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
D014665:Vasodilator Agents; D005996:Nitroglycerin