Q J Med 2001; 94: 267-270
© 2001 Association of Physicians
Chest wall tenderness is unhelpful in the diagnosis of recurrent chest pain
From the Medicine and Cardiovascular Group, Ninewells Hospital, Dundee, UK
Received 21 December 1999 and in revised form 26 January 2001
We investigated whether the presence of chest wall tenderness or fibromyalgia
helped to distinguish between ischaemic and non-ischaemic chest pain.
Seventy-one patients with recurrent chest pain, 36 with normal (group
A) and 35 with abnormal coronary angiograms (group B), were
assessed by investigator-administered questionnaires, and were examined
for chest wall tenderness and fibromyalgia by a single blinded observer. Chest
wall tenderness was greater in group A. However, it was much greater in women,
who predominated in group A, than in men, who predominated in group B, and
this explained the intergroup difference. Seven patients (25%) (six
female, one male) in the group A and one patient (3%) (male)
in group B (
2 p=0.027)
fulfilled criteria for fibromyalgia. Patients with recurrent chest pain are
more likely to have a ischaemic cause if they are male. Although our study
suggests that chest wall tenderness alone in patients with recurrent chest
pain has no value in excluding myocardial ischaemia as a cause, the confounding
factor of gender prevents our study design from answering this question conclusively.
Fibromyalgia is commoner in patients with chest pain and normal coronary angiograms,
but may be related to the excess of females in this group. Its presence does
not preclude the co-existence of ischaemic heart disease.
Address correspondence to Dr T. Pullar, Rheumatic Diseases Unit, Wards 1&2, Ninewells Hospital, Dundee DD1 9SY