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Angina Red Herring.

Myofascial chest pain syndrome frequently masquerades as angina pectoris in women, Dr. Ronald S. Baigrie said at an international conference on women, heart disease, and stroke.

As a result, a large number of women with noncardiac chest pain end up undergoing a detailed cardiovascular work-up and receiving antianginal drugs and even revascularization procedures without symptomatic improvement, said Dr. Baigrie, a Sudbury, Ont., cardiologist.

A 6-week program of corrective physical therapy undertaken by 60 women with probable myofascial chest wall pain resulted in significant improvement in symptoms in 38 of the 48 women who completed the program.

Discrepancies in a patient's history and findings are one way to identify which women with angina-like chest pain are apt to benefit from a physical therapy program for myofascial pain syndrome. Such women may have an exercise stress test result that's positive for ischemia but does not produce chest pain, or they may complain of chest pain with minimal or no physical activity. Particularly common is a history of chest pain elicited by upper body activity but not lower body activity. Such patients may experience profound retrosternal-like chest pain while carrying a grandchild yet have no symptoms while climbing five flights of stairs.

It is useful to ask the patient to hold a 5-pound book at eye level with outstretched arms slightly bent at the elbow. Many women with myofascial chest pain can't hold that position for more than 5-10 seconds before developing chest discomfort.
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Author:Kubetin, Sally Koch
Publication:OB GYN News
Date:Nov 15, 2000
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