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Post-traumatic intercostal neuralgia is underdiagnosed and rarely reported. Amongst the cases reported – acute damage to the thoracic wall and post-thoracotomy period remain the most common causes of intercostal neuralgia. We report a case of a young male who developed neuropathic intercostal chest pain 3 years after a history of trauma. Our case underlines the atypical presentation of delayed-onset intercostal neuralgia, successfully managed by a definite intercostal nerve block after a positive diagnostic block.

Objective: To determine the frequency of raised Mean Platelet Volume (MPV) in patients with acute coronary syndrome (ACS) in HIT Hospital Taxila. Materials and Methods: A case-control study was at HIT Hospital Taxila. All the patients presented with chest pain who fulfilled the inclusion criteria were recruited into the study. Patients with acute coronary syndrome were included in the case group (ACS group). The patients included in the control group (non-ACS group) had chest pain without having ischemic heart disease or risk of ischemic heart disease. Data were analyzed using SPSS version 28. To find out the correlation between the type of chest pain and mean platelet volume chi-square test was applied. Results: Total 93 patients were included in this study. 51 patients were included in the ACS group while 42 were in non- ACS group. To find out the correlation between the type of chest pain and mean platelet volume chi-square test was applied. The results show a significant association between raised MPV and acute coronary syndrome. Conclusion: Patients with raised MPV are at higher risk of acute coronary disease and complications related to it. It could be used as a predictor of ischemic heart disease and its complications. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis (EoE) has evolved over the last three decades with a better understanding of the natural course of the disease. The prevalence of EoE is higher in Western countries with increasing reports of the incidence of EoE in the east. There is less data on EoE in India. We have noticed an increase in the number of cases of EoE diagnosed in our center over the last few years. In this study, all patients with high clinical suspicion of EoE were included and prospectively evaluated with endoscopic features and esophageal biopsies. Seventeen of 73 patients were diagnosed with EoE based on clinical, endoscopic and histopathologic features. One patient was lost to follow-up and 16 of the 17 patients were initiated on standard-of-care treatment and followed up for a minimum of four weeks. Treatment with proton pump inhibitors with six-food elimination diet is highly effective in most patients with a few patients requiring systemic steroids and endoscopic treatment. In conclusion, this study highlights that EoE exists in India with varied manifestations and a high index of clinical suspicion is necessary for diagnosis. It also emphasizes the need for increasing awareness of the entity of EoE, among both patients and doctors. Further, large-scale, multi-centric population-based studies are necessary to estimate the prevalence in our country. [ABSTRACT FROM AUTHOR]

This report presents a case of an acute Type A aortic dissection in a young patient with atypical symptoms, highlighting the importance of prompt radiology-aided diagnosis and intervention. A 29-year-old male with no significant medical history presented with right upper quadrant and epigastric pain, along with leg numbness. Extensive imaging revealed an ascending aortic dissection with a 5.1 cm aneurysm and moderate-to-severe pericardial effusion. After initial stabilization, an emergency Bentall procedure with mechanical valve replacement was performed. It emphasizes the importance of considering aortic dissection in young patients with atypical symptoms, as it can mimic other conditions, complicating timely diagnosis and management. The postoperative course was uneventful, and the patient stabilized in the intensive care unit (ICU). Early recognition and rapid surgical intervention are crucial in managing atypical aortic dissection cases, especially in younger patients with minimal risk factors., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alfazza'a et al.)

Qiuzhen Lin,1– 4 Ousseina Bonkano,1– 5 Keke Wu,1– 4 Qiming Liu,1– 4 Toure Ali Ibrahim,5 Ling Liu1– 4 1Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 2Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, People’s Republic of China; 3Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, People’s Republic of China; 4Cardiovascular Disease Research Center of Hunan Province, Changsha, Hunan, 410011, People’s Republic of China; 5Department of Cardiovascular and Internal Medicine Niger, Niamey Amirou Boubacar Diallo National Hospital, Abdou Moumouni University, Niamey, NigerCorrespondence: Ling LiuDepartment of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, #139 Middle Renmin Road, Changsha, Hunan, 410011, People’s Republic of ChinaFax +86-73185295407Email feliuling@csu.edu.cnBackground: Atypical chest pain in some outpatients could derive from mental disorders. It is necessary for them to have a preliminary emotional assessment in the outpatient department of Cardiology before psychiatric outpatient visits.Methods: This study included 122 Chinese outpatients with atypical chest pain in the department of Cardiology. They accepted routine examinations, including treadmill test, and were judged by the three-question method as highly likely to have emotional disorders. Then, a standard questionnaire package containing the Chinese version of the seven-item scale for General Anxiety Disorder (GAD-7), Self-rating Anxiety Scale (SAS), the nine-item Patient Health Questionnaire (PHQ-9) and Self-rating Depression Scale (SDS) was administered to evaluate anxiety and depression.Results: The percentages of anxiety evaluated by GAD-7 and SAS were 62.3% and 26.2%, respectively. Analogously, the assessment by PHQ-9 showed a significantly higher percentage of depression than that by SDS (61.5% vs 29.5%) (P < 0.05). Kappa analysis showed that the consistency between GAD-7 and SAS, or that between PHQ-9 and SDS was not very good. About 73% outpatients suffered from emotional disorders, presenting as anxiety/depression evaluated by GAD-7 and PHQ-9. Furthermore, sleep disorders accounted for more than 80% of patients with mental disorders. Finally, the suicidal tendency of depression patients was about 17% that should not be ignored.Conclusion: Compared with SAS and SDS, GAD-7 and PHQ-9 detected more participants with emotional disorders in the Chinese outpatients with atypical chest pain, indicating that GAD-7 and PHQ-9 could be briefly well-validated tools to screen emotional disorders in the outpatient department of Cardiology before psychiatric visits.Keywords: depression, anxiety, screen, atypical chest pain

Objective: The incidence of surgically treated thoracic disc herniations in the U.S. is estimated to be 1:116,338 [1]. The disease poses 2 main challenges: 1) Surgical removal and 2) early and correct diagnosis. It is without doubt that herniated thoracic discs can be difficult to remove; Equally difficult is often enough attributing the correct symptoms to the disease that lead to the diagnosis, because there is a great variability and supposedly low specificity of the clinical symptoms, especially concerning pain related symptoms, which are often attributed to muscular or joint related causes.The series published so far are comparatively small (up to a maximum of 200) to give a good and valid overview of the symptoms that the disease can cause.The aim of this study was therefore to verify and falsify the previously published data that were obtained with small series on the basis of a much larger series. Methods: We used our practice's own database that was designed to included only patients with thoracic disc herniations since the senior author focused on this disease about 25 years ago. The patient's symptoms were initially recorded descriptively on the basis of the medical record. Then the patients were contacted and the development of symptoms after surgery and new symptoms were recorded. Results: 664 patients were included in the study. Mean follow-up period was 57.89 months. 151 (22.74%) patients reported neurological motor deficits, 313 (47.13%) reported neurological sensory deficits, 542 (81.62%) thoracic back pain, 125 (18.82%) bladder and rectal dysfunction and 46 (6.92%) atypical symptoms. 137 (20%) of the patients were completely symptom-free. The rate of improvement/ symptom stability was about 90% for neurological symptoms, pain-improvement 40%, 65% improvement in bladder and rectal dysfunction, and 80% improvement in atypical symptoms. Conclusion: The results of this largest series to date of patients who were operated on for a thoracic disc herniation show that not only neurological but also algetic symptoms are dominating in patients harboring this disease. The postoperative results primarily help to advise the patient on their prognosis.

Contrast-enhanced chest computed tomography (CT) is not considered part of the evaluation of myocardial infarction. However, acute myocardial infarction has been detected on contrast-enhanced chest CT as areas of decreased myocardial enhancement in patients evaluated for other indications, such as pulmonary embolism and aortic dissection. We present a case of acute myocardial infarction on a nongated chest CT in a 67-year-old male who presented with atypical chest pain and initial nondiagnostic electrocardiogram. This case highlights that acute myocardial infarction may be detectable on contrast-enhanced CT. When evaluating contrast-enhanced chest CT's for other etiologies of chest pain, radiologists should look for potential myocardial perfusion abnormalities that can provide clues to the presence of myocardial infarction.

Aortic dissection is a critical and life-threatening condition that can present with atypical symptoms, often leading to misdiagnosis and delayed treatment. The report presents a case of a 65-year-old male who initially exhibited fever, right-sided chest pain, and a productive cough, resulting in an initial diagnosis of pneumonia. Despite empirical antibiotic therapy, his symptoms persisted, prompting further investigation. A computed tomography (CT) scan ultimately revealed a Type B aortic dissection. The patient was then transferred to a specialized tertiary care facility for successful endovascular intervention. This case underscores the importance of considering aortic dissection in patients presenting with persistent, atypical symptoms that do not respond to standard treatments, such as unexplained fever and chest pain. It highlights the crucial role of advanced imaging techniques, such as CT scans, in achieving an accurate and timely diagnosis. Clinicians must maintain a high index of suspicion and ensure prompt referral to specialized centers to improve patient outcomes in this potentially fatal condition., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Singh et al.)

Traumatic diaphragmatic rupture is not a common injury in children. It is an important cause of morbidity and mortality, though diagnosis may be missed or delayed with atypical clinical presentation and confounding radiological features. A 4-year-old male presented with periumbilical abdominal pain, bilious vomiting, fever and progressive difficulty in breathing for two days. He had complained of vague left-side chest pain on return from the swimming pool about 6 weeks earlier. An initial chest radiograph showed a non-outlined left hemidiaphragm, a left pneumothorax, rightward mediastinal shift and suspected bowel in the chest. He could not afford a CT scan, hence a repeat chest radiograph was performed, which outlined the stomach with an air-fluid level in the left hemithorax.

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Pulmonary embolism (PE) is a common but life-threatening condition, and diagnosis can be challenging. Diagnosis is even more difficult in those patients with atypical presentations such as the absence of pleuritic chest pain, dyspnoea, tachycardia, or symptoms of deep vein thrombosis. We have delineated shoulder and back pain as an atypical sign of PE. However, the significant amount of misdiagnosis highlights the importance of other rare symptoms of this potentially fatal disease. Therefore, eliciting these rare presenting symptoms can significantly reduce morbidity and mortality. Here, we report the case of a patient who, 13 days after a laparoscopic Nissen fundoplication, presented to the emergency department (ED) with left shoulder and left-sided pleuritic back pain. She was managed in the resuscitation area in the ED and was subsequently diagnosed with a left-sided PE. Her care was taken over by the medical team, and she continued her recovery in the acute medical unit., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nwaneri et al.)

Cardiac syndrome X (CSX) is a cardiac condition that is a diagnosis of exclusion. Patients usually present with terrible chest pains suggestive of myocardial infarction, but angiogram imaging shows no occlusion in the coronary vessels that would be suggestive of coronary artery disease. CSX is more commonly seen in women, but this case report demonstrates a different clinical presentation of CSX in a young, otherwise healthy male patient. The 38-year-old male patient presented to the emergency room with chest discomfort radiating to the left arm and to the left jaw. The chest pain started after the patient went for a jog, with the pain lasting for a couple of hours. The electrocardiogram (ECG) was abnormal, showing nonspecific ST changes and unremarkable troponin levels. The patient underwent a coronary angiogram, which was unremarkable. Three years later, the patient presented once more with chest heaviness that occurred again after going for a run. The patient's troponins were unremarkable, and an ECG test showed a new onset of AV block. Due to the ongoing chest pain, the patient received another coronary angiogram. This showed that the coronary vessels had no indications of occlusion. The patient was discharged and scheduled to follow up with their cardiologist for an extensive discussion about medications for their condition. This case report should bring awareness of the classical presentation of this disease in an uncommon population group and a way to identify this syndrome once exclusions have been made on previous hospitalizations., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zuyev et al.)

Patients with acute nonspecific chest pain and low probability for coronary disease remain an important clinical management dilemma. We focus on evidence for imaging, in an integrated decision-making setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Patients with acute nonspecific chest pain and low probability for coronary disease remain an important clinical management dilemma. We focus on evidence for imaging, in an integrated decision-making setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear. Methods: We studied 977 patients who presented with recurrent typical or atypical chest pain in outpatient clinic. All patients have undergone detailed clinical examination, ECG stress testing and coronary computed tomography angiography. Results: Highest positive prediction for having myocardial bridging was for patients presenting with atypical chest pain with negative ECG stress test and who were younger women. Conclusion: Coronary computed tomography angiography may be preferable method for evaluation of chest pain in younger women presenting with atypical chest pain.

Introduction: Coronary artery fistulas are usually incidental findings and rarely cause any clinical symptoms.

Background: Acute chest pain is a common presentation in emergency departments worldwide. Differentiating between cardiac and non-cardiac chest pain is crucial for patient management and resource allocation., Methods: This study analyzed 714 patients presenting with acute chest pain in a tertiary care hospital in North India. We investigated demographic characteristics, chief complaints, risk factors, ECG findings, and final diagnoses to identify patterns associated with cardiac (CCP) and non-cardiac chest pain (NCCP)., Results: CCP was diagnosed in 53.7% (n=383) and NCCP in 46.3% (n=331). Significant predictors of CCP included age (OR=1.05, p<0.001), smoking (OR=2.22, p<0.001), diabetes (OR=1.57, p=0.003), hypertension (OR=1.82, p<0.001), and family history of ischemic heart disease (IHD) (OR=1.42, p=0.01). Central chest pain was more common in CCP (60% vs. 40%, p<0.001), as were abnormal ECG findings such as ST-segment depression (35% vs. 10%, p<0.001) and elevation (29% vs. 6%, p<0.001). Normal ECG was more prevalent in NCCP (60%, p<0.001)., Conclusion: Traditional cardiovascular risk factors remain strongly associated with CCP. Smoking has a particularly high odds ratio, suggesting the need for targeted interventions. ECG findings significantly aid in differentiating CCP from NCCP. This study underscores the importance of a comprehensive approach in evaluating acute chest pain to ensure accurate diagnosis and effective treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mateen et al.)

BACKGROUND AND OBJECTIVE: Acute chest pain is caused by different reasons and about 20% of them are caused by myocardial ischemia. Since the number of patients with chest pain admitted to emergency wards is daily increasing, the present study was conducted to compare the exercise test results with coronary angiography in patients with atypical chest pain. METHODS: This cross-sectional study was conducted among patients with acute chest pain in Babol from 2007 to 2009. Exercise tests were run for patients and if the result was positive, coronary angiography was performed and they were compared. FINDINGS: 779 patients (394 males, 385 females) over 45 years with atypical chest pain underwent exercise test and the result was positive for 256 patients. 105 females and 151 males with positive exercise test results as well as patients with negative exercise test results underwent coronary angiography. Of 580 patients who underwent coronary angiography (256 patients with positive exercise test results and 324 patients with negative exercise test results), 276 patients (47.5%) suffered from coronary artery disease (CAD) and the prevalence of coronary artery disease (CAD) was 77% in patients with positive exercise test results and it was 24% in patients with negative exercise test results. CONCLUSION: Considering the high prevalence of coronary artery disease (CAD) in patients with positive exercise test results, this test is recommended as a primary detection method for patients with atypical chest pain.

Background: Approximately a quarter of the global population experiences chest pain during their lifetime worldwide. Although largely non-life-threatening, many patients experience mental, physical, social, and financial consequences., Aim: This study aimed to describe and determine the epidemiology and consequences of patients presenting with atypical chest pain (ACP).  Method: Data were obtained from 102 participants, from a desired sample size of 166. The target population was patients who presented with ACP at the Accident and Emergency Department of a Teaching Hospital in Trinidad during a two-year period, from January 2021 to December 2022. The data collection instrument used was a 34-item online questionnaire. Data were analyzed using both descriptive and inferential statistical methods., Results: Participants were predominantly women (63.7%; n = 65), between 31 and 50 years of age (74.5%; n = 76), in full-time employment (n = 58; 56.9%), who lived with at least one person (90.2%; n = 92) at the time of the episode. Overall, 61.8% (n = 63) reported having a stressful life. Hypertension (30.4%; n = 31) and diabetes (18.6%; n = 19) were the leading comorbidities. Participants experienced mild to severe anxiety (53.9%; n = 55), moderate to severe depression (25.5%; n = 26), moderate stress (65.7%; n = 67), and loneliness (25.5%; n = 26). A stressful life was associated with, and was a predictor of, both anxiety and loneliness. No sociodemographic variables were associated with depression or stress. The most common self-reported consequences were "fear as a result of the pain" (68.6%; n = 69), "interruptions to daily life" (60.8%; n = 61), "reduction in time spent on hobbies" (62.7%; n = 63), and costly diagnostic/investigative tests (62.7%; n = 64). The majority of patients (52.9%; n = 53) reported reduced quality of life. The most common treatment prescribed was paracetamol (53.9%; n = 55) and exercise (23.5%; n = 24)., Conclusion: The study participants were mainly women, 31-50 years old, who had experienced anxiety, stress, or depression. They mainly experienced fear and self-reported a reduced quality of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Bahall et al.)

Introduction: Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear. Methods: We studied 977 patients who presented with recurrent typical or atypical chest pain in outpatient clinic. All patients have undergone detailed clinical examination, ECG stress testing and coronary computed tomography angiography. Results: Highest positive prediction for having myocardial bridging was for patients presenting with atypical chest pain with negative ECG stress test and who were younger women. Conclusion: Coronary computed tomography angiography may be preferable method for evaluation of chest pain in younger women presenting with atypical chest pain. [ABSTRACT FROM AUTHOR]

Objective:To determine and compare the frequency, clinical characteristics and outcomes of patients reporting in Emergency Department of AFIC& NIHD with typical and atypical chest pain. Study Design: Comparative cross-sectional study. Place and Duration of Study: Emergency Department of Armed Forces Institute of Cardiology & National Institute of Heart Diseases Rawalpindi, from 1stDecember 2016 till 31stDecember 2016. Material and Methods: All the patients presented with typical and atypical chest pain during our study time period were included in the study. A data collection tool was formulated by R & D Department to collect the relevant information. Results:There were total 215 patients recruited with chest pain in emergency department during our study period. The mean age of the patients was 56.17 ±10.98 years. 130(60.4%) patients had typical chest pain while 85(39.5%) patients presented with atypical chest pain. Male patients were found to be more with typical chest pain 105(80.7%). Clinical Characteristics and co-morbidities showed, diabetes in 58(44.6%) patients of typical chest pain (p=0.01), 65 (50.0%) patients were hypertensive (p=0.88) and 36(27.6%) hadischemic heart disease (p=0.02). Family history of cardiovascular disease was positive in 34(26.1%) withp-value=0.01. The most common diagnosis of typical chest patients were acute myocardial infarction 80(37.9%) with statistically significant p value (p<0.01).Underlying causes for the majority of atypical chest pain patients 77(90.5%) were gastric causes and anxiety related issues (p=0.01). About 25(11.6%) patients under went primary PCI, injection streptokinase were administered to 15(11.5%) patients, 16(12.3%) patients were late for injection streptokinase, 15(11.5%) patients were referred to OPD while 53(40.7%) were admitted for further evaluation. Conclusion: Patients with life threatening etiologies for chest pain may appear deceptively well, manifesting neither vital sign nor physical examination abnormalities. Emergency doctors must recognize and refer them for treatment and hospital admission. [ABSTRACT FROM AUTHOR]