Clinical & Experimental Cardiology
Open Access

An Overview on Non-Specific Chest Pain (NCCP)

Maria Johann^{* *}Correspondence: Maria Johann, Department of General Internal Medicine, University of Bern, Bern, Switzerland, Email:

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Description

Between 1% and 3% of adults will present with chest pain seeking primary care for the first time each year. In people for whom coronary heart disease is considered to be a diagnostic possibility, general practitioners or family physicians may pursue investigations and identify angina or a noncoronary aetiology such as gastric disease, musculoskeletal disease, or anxiety. Many people, however, will not be given a precise diagnosis and instead will be thought to have a cause for their chest pain that is unknown. Unattributed chest pain sufferers had higher rates of risk factors for future cardiovascular events than the general population, and they are more likely to develop cardiovascular disease in the future than people without chest pain.

Priority one for patients who report to the Emergency Department (ED) with chest discomfort is to rule out any potentially fatal conditions such Acute Coronary Syndrome (ACS), pulmonary embolism, aortic dissection, or pneumonia. 60% to 90% of patients presenting with chest discomfort can have an acute myocardial ischemia ruled out following a comprehensive diagnostic evaluation. While the proportion of patients with ACS may be higher in specialist units like critical care and cardiac care units, it has dropped in the US emergency departments from 23.6% in 1999-2000 to 13.0% in 2007-2008. Patients are typically released with the diagnosis of non-cardiac chest pain when no particular condition that is causing the chest discomfort can be detected.

Patients with NCCP can be divided into two groups: those with and those without a known underlying illness (i.e. non-specific chest pain). According to some estimation, up to 50% of patients who are discharged with NCCP have an underlying psychological condition or gastroesophageal reflux illness. Furthermore, musculoskeletal illnesses commonly cause chest pain. Even though patients with NCCP who were discharged from the ED had low mortality rates, 90% of them reported ongoing symptoms and poor quality of life during a 4-year follow-up. Despite having normal coronary angiograms, 50% of NCCP patients felt difficulties in their everyday activities, and 44% continued to believe they had an underlying heart condition.

As a result, individuals with NCCP who have their major emphasis on excluding cardiovascular illness may undergo unnecessary tests without feeling more secure. Additionally, individuals without ischemic electrocardiographic changes or chest discomfort can have elevated troponin test findings, and in a retrospective analysis, increased troponin test results did not have any clinical significance but did prompt further testing. In order to distinguish between patients with Non-Specific Chest Pain (NCCP) and those who have other underlying disorders that present with NCCP, the clinical issue is to decide which diagnostic tests to administer to patients with chest pain once a cardiac condition has been ruled out.

For example, a high dose Proton Pump Inhibitor (PPI) treatment trial may be helpful in identifying individuals with underlying Gastro-Esophageal Reflux Disease (GERD), and screening methods may be able to spot people with underlying panic or anxiety disorders. The diagnostic procedures and treatment suggestions for patients who are discharged from the ED with a diagnosis of NCCP are currently under-studied and primarily rely on the doctors' individual perspectives and experiences. The majority of patients did not have a diagnosis recorded at first presentation or in the following 6 months, and most did not undergo diagnostic testing, according to our previous study of 1,72,000 patients who presented for the first time with chest pain in UK primary care between 2002 and 2009.

Discoveries in individuals documented with unattributed chest pain had a higher risk of cardiovascular events, including myocardial infarction specifically, over 5 years compared with those diagnosed with non-coronary chest pain. Although the risk of future myocardial infarction was lower than in individuals originally identified with angina, the absolute number of patients with a future myocardial infarction was about 5 times higher in the cohort with unattributed chest pain because of its bigger size.

Since the 2002-2009 time period examined in our previous study, there have been changes in the way that chest pain is investigated. Most high income countries have implemented rapid-access chest pain clinics in secondary and tertiary care for quick specialist review, investigation and treatment. Non-invasive investigations like computed tomography coronary angiography and stress perfusion functional imaging have replaced more invasive investigations like coronary angiography. The threshold for diagnosing acute coronary syndromes/acute myocardial infarction has changed due to the development of high- sensitivity cardiac troponin assays that can identify subtler variations in cardiac enzymes released after myo-necrosis, which may have an impact on the relationships we have previously reported.