A Review of Chest Pain in Nigerian Hypertensive Patients Presenting to the Out-Patient's Clinic of a Teaching Hospital

In a prospective 6-month study; chest pain was reviewed in hypertensive man above 40 years and post menopausal women on antihypertensive therapy. The subjects were made up of 230 volunteers made up of 101 males and 129 females. Their mean age was 54.5 + 10 years (males 51.3 + 8.9 years vs. female 53.3 + 9.8 years). Forty seven percent of subjects admitted to pain as being located in the retrosternal area; in 38 it was cited at the precordial area and the remainder (9) cited the pain on the right side of the chest and 6 submamary. Twenty six percent and 22 of subjects described pain as being pressure like or dull consecutively. In 42 of patients pain was aggravated by exertion; in 32 of subjects pain had no aggravating factor; 14 and 3 had pain aggravated by hunger and the use of non steroidal anti-inflammatory agents. In the remaining 9 pain was aggravated by breathing particularly during the inspiratory phase of respiration. The relieving factors described include rest in 34; analgesia in (25); change of position in 4 and antacid in 12. In the remaining 25 no relieving factor was identified. Pain radiation was described was mainly to the epigastrium. Based on the symptoms; 11 had all the three parameters of pain description suggestive of angina pectoirs. 5 of patients had symptom suggestive of atypical angina and 17 had just one character present and considered non cardiac. The difference in serum cholesterol level in patients described as having classic angina and atypical were statistically significantly higher than those in subjects who did not complain of chest pain. Patients with atypical chest pain had the highest blood pressure; those with non cardiac pain had the highest WHR while those with no pain had the highest BMI. A proper approach to patients with chest pain irrespective of how trivial it may seem; should include a careful description and characterization of the chest pain; careful and a thorough physical examination. A rational and judicious utilisation of facilities should be employed carrying out the available investigations and possibly following chest pain protocols.

Chest pain: An approach for family practice

Chest pain is a common symptom in clinical practice and has many aetiological factors. A rapid but systematic assessmentof patients in a primary care setting is essential to identify those with potential life-threatening aetiologies of chest pain. Once a life-threatening aetiology has been excluded; a correct diagnosis can be derived from a careful history; physical examination and a few selected investigations. A patient can then be referred to a hospital or a specialist for further evaluation. Not every patient needs to be referred

La douleur thoracique en pratique. Cardiologie quotidienne a Bamako

"Il s'agit d'un travail prospectif realise dans le Service de Cardiologie de l'Hopital du Point ""G"" de janvier 1991 a decembre 1991. L'echantillon etait constitue de 100 patients. La predominance est feminine jusqu'a 45 ans et masculine au dela. La moitie environ (53 pour cent) des malades a un passe cardio-respiratoire. Les menageres predominent 33 pour cent. Plus de la moitie des malades sont sans facteurs de risque (63 pour cent) essentiellement des femmes 74;6 pour cent. Parmi les patients avec facteur de risque 37 pour cent les hommes dominent 67;6 pour cent. Le tabac et l'hypertension arterielle sont les plus courants facteurs de risque avec respectivement 45;9 pour cent et 18;9 pour cent. La douleur est le plus souvent de siege mediothoracique (82;3 pour cent)."

Asymmetric septal hypertrophy and systolic anterior motion of the mitral valve in a patient with pulmonic stenosis and complete heart block: a rare association [case report]

Apart from hypertrophic cardiomyopathy; asymmetric septal hypertrophy has been reported in many disease entities. Its association with pulmonic stenosis although not unknown is none the less rare (1;2). We present the case of a 21 year old back female student who presented with a 2 day history of chestpain; dyspnoea and syncope. She had intermittent dizziness exertional dyspnea and palpitations in the antecedent nine years. She also later admitted to progressive effort intolerance since childhood. Her referal letter stated that she was diagnosed as having hypertrophic cardiomyopathy. The previous echo had been prompted by a University preadmission electrocardiographic finding of multiple multiforal ventricular ectopics