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Chest Pain in Emergency Department Patients: If the Pain is Relieved by Nitroglycerin, is it More Likely to be Cardiac Chest Pain?

Published online by Cambridge University Press:  21 May 2015

Robert Steele ,
Timothy McNaughton ,
Melissa McConahy  and
John Lam
Robert Steele*
Affiliation:
Loma Linda University Medical Center, Loma Linda, Calif.
Timothy McNaughton
Affiliation:
Loma Linda University Medical Center, Loma Linda, Calif.
Melissa McConahy
Affiliation:
Loma Linda University Medical Center, Loma Linda, Calif.
John Lam
Affiliation:
Loma Linda University Medical Center, Loma Linda, Calif.
*
Emergency Department, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda CA 92354

Abstract

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Introduction:

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.

Design:

Prospective observational cohort study with a 4-week follow-up of patients enrolled.

Setting:

Academic tertiary care hospital, with 60 000 visits/year.

Inclusion criteria:

Adult patients presenting to the emergency department with active chest pain who received nitroglycerin and were admitted for chest pain.

Exclusion criteria:

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.

Keywords

chest painnitroglycerin
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 3 , May 2006 , pp. 164 - 169
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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