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Background: Recurrent atypical chest pain not due to cardiac illness is a very common condition in medical outpatient departments. Authors found that people consulting for atypical chest pain often have significant Vitamin D deficiency and correction of Vitamin D deficiency relieved patient symptoms. Hence authors carried out this study.Methods: Persons aged below 50 years were taken up for study. Those attending medical clinics with complaints of chest pain occurring more than two times were taken up for study. Cardiac illness was excluded by clinical examination and investigations. Those found to have low Vitamin D were taken up for study. 60,000 international units Vitamin D was administered orally weekly for 8 weeks. They were followed up twice weekly for three months and once monthly for three months.Results: Results were analyzed and charted. 120 subjects were taken up for study and duration of study was three years. Average age of the study group was 37.50 years and the average Vitamin D level was 15.75 nanogram/ml (ngm/ml). Duration of chest pain ranged from one week to one year. Most of the patients had migratory chest pain.Conclusions: As Vitamin D deficiency is a treatable medical condition it may be prudent to check Vitamin D levels in the patients presenting with recurrent atypical pain in the chest. It reduces the burden on the health care system and relieves the suffering of the patient. It may not be futile to check Vitamin D levels even in the patients with coronary artery disease who are suffering from atypical chest pain.
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PURPOSE: To identify the causes and clinical characteristics, and the efficacy of various diagnostic approaches, we studied, prospectively, pediatric patients with chronic recurrent chest pain. METHODS: A prospective study of 122 patients with chronic recurrent chest pain from June 1998 to June 2003 was performed. The male and female ratio was 81:41, age 9.3+/-3.1 year. A single chart including pain description(histoy) and pain questionaire, with associated symptoms, was used for systematic history taking. The patients were devided in two groups, Group A, before June 2001(n=70), Group B, after June 2001(n=52). Chest X-ray and ECG were checked in all patients. Allergy tests and echocardiography, 24 hour ECG monitoring, exercise tests, pulmonary function tests, and gastrointestinal fiberendoscopy were performed selectively. RESULTS: Idiopathic origins were most common(32%). The remaining causes were psychogenic(23%) and exercise-induced asthma(20.5%), hyperventilation syndrome(9.1%), tachyarrhythmia(4.9%), cardiac (4.1%), pulmonary(3.3%), reflux esophagitis(2.5%), in order. The positive rate of allergy tests(24%) was higher than that of cardiac examinations(11-20%). Exercise-induced asthma was more common than psychogenic causes after June, 2001. Various abdominal symptoms accompanied idiopathic and psychogenic chest pains, and hyperventilation syndrome. Headaches were more commonly found in psychogenic pain, but chest tightness and dyspnea were common in hyperventilation syndrome. About half of exercise-induced asthma patients had symptoms of allergic rhinitis. CONCLUSION: In the majority(72%) of exercise-induced asthma, the chest pain was induced or aggravated by exercise, and relieved by rest. Causative antigens were detected in 69.2% of group B patients with exercise-induced asthma. Exercise-induced chest pain might be a first manifestation in allergy patients. So, we recommand allergy tests for patients with recurrent chest pains induced or aggravated by exercise. Hence, cardiac examinations such as echocardiography or 24 hour ECG monitoring could be performed selectively, case by case.