Non-cardiac Chest Pain Evaluation and Treatment Study (CARPA) - Part 1: Diagnosis.
Condition: Non-Cardiac Chest Pain; Undiagnosed Chest Pain; Musculoskeletal Chest Pain; Ischemic Heart Disease
MeSH terms: Heart Diseases; Myocardial Ischemia; Coronary Artery Disease; Chest Pain
Study type: Observational

Summary: 
      The overall aim of the project is to evaluate diagnosis and treatment of chest pain
      originating from the musculoskeletal system. Specifically, we wish to investigate prevalence
      and character of such chest pain in a population of patients with acute chest pain, admitted
      to a university hospital based acute chest pain clinic, and undergoing evaluation of acute
      coronary syndrome (Part 1). Then, to test a manually-based treatment protocol to patients
      with diagnosed musculoskeletal chest pain in a randomized clinical trial (Part 2).

      The specific purpose of this study (Part 1) is to determine the exact number of patients with
      acute chest pain origination from the musculoskeletal system, and to describe their cardiac
      status with respect to ischemic heart disease. Further, we wish to evaluate the decision
      making process of the chiropractor.
    

Detailed description: 
      Acute chest pain is a common reason for hospital admission. The focus of diagnosis is of
      course pain of cardiac origin including myocardial infarction and/or other ischemic heart
      disease; however, in up to 50% of cases the aetiology may be non-cardiac. Differential
      diagnoses include primarily pulmonary, gastrointestinal, psychosocial, or musculoskeletal
      problems, and musculoskeletal problems may account for around 20% of the total number of
      admissions in acute chest pain clinics. Thus the musculoskeletal system is a recognized
      possible source of pain in patients with chest pain even though a confident diagnosis of
      musculoskeletal chest pain can be difficult to establish since no gold standard exists to
      verify this diagnosis.

      Chest pain patients with normal coronary anatomy have an excellent prognosis for survival and
      a future risk of cardiac morbidity similar to that reported in the background population.
      However, about three quarters of patients with non-cardiac chest pain continue to suffer from
      residual chest pain with large socio-economic consequences. Therefore, a search for an
      alternative cause with related possibilities for treatment is warranted. Given these
      perspectives, the general objective of the present work is to study the diagnosis of chest
      pain originating from the musculoskeletal system of the cervical and thoracic spine, and
      thorax in patients with chest pain of various origins, and to evaluate ischemic heart disease
      status among patients with presumed musculoskeletal pain.

      Evaluation:

      Patients with musculoskeletal chest pain will be identified using a standardized examination
      protocol comprised of a semi-structured interview, a general health examination, and a
      specific manual examination of the muscles and joints of the neck, thoracic spine and thorax.
      All patients will have a Myocardial Perfusion Imaging (MPI) performed and results from the
      MPI will be compared with the musculoskeletal status. Specific important parameters of the
      standardized examination protocol will be identified and the decision making process of the
      chiropractor will be evaluated.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Three hundred consecutive patients with an episode of suspected non-cardiac acute chest
        pain will be recruited from among patients discharged from an acute chest pain clinic
        situated at a large specialized cardiology department.
      
Keywords: Chest Pain; Chest Wall; Angina Pectoris; Atypical Chest Pain; Physical Examination; Myocardial Perfusion Imaging; Observational Study; Non-Cardiac Chest Pain; Ischemic Heart Disease