Evaluation of chest pain: a cardiology perspective for gastroenterologists.

Evidence indicates that there is a strong cardioesophageal connection inpatients who experience esophageal or ischemic problems. Cardiologists and gastroenterologists often find the coexistence of symptoms and functional abnormalities, but determining causation is much more difficult. There isa need for better understanding of the phenomenon of cardiac and NCCP,among cardiologists and gastroenterologists. In evaluating chest pain, the cardiologist assesses the probability that the condition is acute and life threatening; serious and chronic; or noncardiac in nature. If it seems to be cardiac chest pain, appropriate therapy is initiated. In patients in whom there is a strong suspicion of NCCP, a PPI is often prescribed, or the patient is referred to a gastroenterologist or a primary care physician for further evaluation.

Effects of metoprolol CR/XL on mortality and hospitalizations in patients with heart failure and history of hypertension.

BACKGROUND: We describe the effect of controlled-release/extended-release (CR/XL) metoprolol succinate once daily on mortality and hospitalizations among patients with a history of hypertension complicated by chronic systolic heart failure. METHODS AND RESULTS: We enrolled 3,991 patients with chronic heart failure of New York Heart Association functional class II-IV with an ejection fraction of < or = 0.40, stabilized with optimum standard therapy, in a double-blind randomized placebo-controlled study. A total of 1,747 patients (44%) had a history of hypertension; 871 were randomized to receive metoprolol CR/XL and 876 to receive placebo. Treatment with metoprolol CR/XL compared with placebo resulted in a significant reduction in total mortality (relative risk [RR], 0.61; 95% confidence interval [CI], 0.44-0.84; P =.0022), mainly because of reductions in sudden death (RR, 0.51; 95% CI, 0.33-0.79; P =.0022) and mortality from worsening heart failure (RR, 0.49; 95% CI, 0.25-0.99; P =.042). Total number of hospitalizations for worsening heart failure was reduced by 30% in the metoprolol CR/XL group compared with placebo (P =.015). Metoprolol CR/XL was well tolerated: 12% fewer patients withdrew from study medication (all-cause) compared with placebo (P =.048). CONCLUSIONS: A subgroup analysis of MERIT-HF shows that patients with heart failure and a history of hypertension received a similar benefit from metoprolol CR/XL treatment as all patients included in the total study.