Etiology And Epidemiology

There are multiple structures within the chest from where a pain may originate (Table 39.1). In a primary care

• between 20 and 48 percent of consultations for chest pain were thought to be musculoskeletal in origin;

• 13-30 percent gastroesophageal reflux;

• 13 percent costochondritis;

• 10-17 percent cardiac cause/stable angina pectoris;

• 1.5 percent unstable angina pectoris/myocardial infarction;

• 9.5 percent undiagnosed.

It has been estimated that 12 percent of the population will experience chest pain lasting more than 24 hours in a six-month period.3 The majority of resources are directed to the diagnosis, treatment, and exclusion of the cardiac causes.

The healthcare economics of chest pain have not been widely studied. In the United States, there are over 4.6 million visits a year to emergency departments for non-traumatic chest pain.4 In 1998, Medicare beneficiaries were paid nearly US$11 billion for coronary artery disease.5 A Swedish study of over 1000 patients attending a university hospital emergency department, with cardiac chest pain6 for assessment and therapy, on average cost 26,800 SEK (€2900, US$3000, or £1900) per visit.

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