CHEST PAIN - ESOPHAGEAL, CARDIAC, OR BOTH

  • 1 January 1985
    • journal article
    • research article
    • Vol. 80  (5) , 320-324
Abstract
The esohpagus may be the origin of chest pain clinically indistinguishable from that of ischemic heart disease. In some patients the esophageal origin of the pain may only be recognized by pharmacological provocation during manometry. Nine paitents with chest pain which could be explained by disorders of esophageal motility-diffuse spasm in 4 high pressure lower esophageal sphincter in 3 and nutcracker esophagus in 2 are described. Methacholine provoked the pain and manometric abnormalities in 5 patients who had normal baseline tracings. However, 7 patients given methacholine developed ischemic changes on the ECG. In 1 patient these were typical of Prinzmetal''s variant angina. The manometric and ECG abnormalities were reversed by i.v. atropine. Ischemic heart disease and esophageal motor disorders may occur concomitantly and pose a dilemma in diagnosis and management.