Additional Support Necessary

The Interdisciplinary Management of Acute Chest Pain by Dr. med. Raphael R. Bruno, Prof. Dr. med. Norbert Donner-Banzhoff, Prof. Dr. med. Wolfgang Söllner, Prof. Dr. med. Thomas Frieling, Prof. Dr. med. Christian Müller, and Prof. Dr. med. Michael Christ in issue 45/2015

We thank the authors for their successful presentation (1). However, even after excluding relevant cardiovascular or pulmonary diseases, there is still a group of patients remaining who experience relevant complaints. In fact, the associated nervous tension often leads to relapses, which can in turn lead to numerous admissions to the hospital. Therefore, and based on my experience, additional support is required. Attention should be paid to the causes of frequent musculoskeletal pain in terms of functional disorders of the skeletal and locomotor systems. Research has revealed that about half of these patients have problems in the areas of ​​the shoulder, neck, thoracic spine, or sternocostal compound joints (2). At least one-quarter of the patients had symptoms of fibromyalgia or true inflammatory joint disease (2). Additionally, herpes zoster in its initial stage should be considered (3). In some cases, pseudo–angina pectoris pain can be attributed to disc herniation, even in the lower cervical spine (4). Unusual pathologies, such as arthritis of the sternoclavicular joint, are rarely the basis for non-cardiac chest pain. After excluding life-threatening diseases, I believe that a strong collaboration with orthopedic pain specialists is necessary to achieve a good treatment outcome and to provide the patients with explanations for their complaints and treatment approaches.

DOI: 10.3238/arztebl.2016.0362a

Dr. med. Thomas Bambach

Neumarkt

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Bruno RR, Donner-Banzhoff N, Söllner W, Frieling T, Müller C, Christ M: The interdisciplinary management of acute chest pain. Dtsch Arztebl Int 2015; 112: 768–80

2. How J, Volz G, Doe S, Heycock C, Hamilton J, Kelly C: The causes of musculoskeletal chest pain in patients admitted to hospital with suspected myocardial infarction. Eur J Intern Med 2005; 16: 432–6

3. Ayloo A, Cvengros T, Marella S: Evaluation and treatment of musculoskeletal chest pain. Prim Care 2013; 40: 863–87

4. Grgic V: Cervicogenic angina. Chest pain caused by unrecognized disc herniation at the segment C 6-C 7: a case report. Lijec Vjesn 2008; 130: 234–6