CHEST AUSCULTATION

Chest auscultation



Chest auscultation

Introduction

Chest pain is a symptom that can indicate a grave, life intimidating condition, and it affects a every day life of many people. In a United States, chest pain outcomes in 5% of all emergency department visits or approximately six million visits per year. However, less than half of these patients are identified with a cardiac condition and over 50% are identified with “non-cardiac” chest pain, which may concern to a variety of disorders including musculoskeletal conditions.

Not surprisingly, patients with non-cardiac chest pain have a good prognosis for survival, but for many of these patients chest pain continues to present a problem . Seventy five percent experience new episodes of pain, which in 20 percent leads to further contact with the health care system ([Ockene et al., 1980], [Launbjerg et al., 1997] and [Best, 1999]). This is probably since the diagnosis of non-cardiac chest pain does not result in new treatment initiatives and as a result leaves the patients worried . In order to clinically differentiate sub-groups of patients with non-cardiac chest pain and to optimize information and treatment plans, further diagnostic initiatives therefore appear warranted.

Assessment and management of musculoskeletal chest pain, or even mid back pain, have largely been empirically based; however, in 2005, Christensen et al. developed a standardized examination protocol with the purpose of identifying patients with musculoskeletal chest pain through systematic examination .

Methods (Gibbs Model)

Study population and recruitment

This study is part of a larger study addressing diagnosis and manual treatment of musculoskeletal chest pain. Inclusion and exclusion criteria are presented in Table 1 and have been described in detail elsewhere . In brief, for this part of the study, 80 patients were included from September 2007 to March 2008. Patients with non-specific chest pain were recruited from the emergency cardiology department at Odense University Hospital, Denmark. All patients had been admitted with suspected acute coronary syndrome. To identify chest pain patients with non-cardiac chest pain, one of the authors (MJS) scanned the patient medical records for inclusion and exclusion criteria (Table 1). Following discharge from the hospital, eligible patients were contacted, and written consent was obtained from those willing to participate. In case of doubt concerning eligibility of a patient, the medical record was presented to an experienced cardiologist and consensus was reached. The patients were examined in this study within two weeks following their episode of acute chest pain. Approval has been granted by the regional ethics committee for Funen and Vejle Counties, Denmark, approval number VF 20060002.

Table 1. Inclusion and exclusion criteria.

Inclusion criteria

Exclusion criteria

Participants included had to

• Have chest pain as their primary complaint

• Have an acute episode of pain of less than 7 days duration before admission.

• Consent to the standardized evaluation program at the cardiology department.

• Have pain in the thorax and/or neck.

• Be able to read and understand Danish.

• Be between 18 and 75 year of age.

• Be a resident of the Funen County, Denmark.

Patients were not included if any of the following conditions were present

• Acute coronary ...