In a patient with chest pain where MI is ruled out, which history clue might suggest GI-induced chest pain?

In a patient with chest pain where MI is ruled out, which history clue might suggest GI-induced chest pain?

• A. Chest pain worsened with exertion
• B. Hot or cold drinks in excess, large food bolus
• C. Dizziness on standing
• D. Frequent productive cough

Answer: (B)

GI chest pain often comes from the esophagus. After MI is ruled out, a telling history clue is pain that is linked to ingestion or swallowing, such as taking in a large meal or very hot or cold liquids. Esophageal distension or spasm from a large bolus or temperature change can produce retrosternal chest pain that mimics angina. This is why a patient who reports chest pain after consuming a large meal or after drinking very hot or cold beverages points toward a GI source, rather than heart, lung, or orthostatic causes. In contrast, pain worsened with exertion suggests ischemia, dizziness on standing points to orthostasis, and a frequent productive cough suggests a pulmonary process.

GI chest pain often comes from the esophagus. After MI is ruled out, a telling history clue is pain that is linked to ingestion or swallowing, such as taking in a large meal or very hot or cold liquids. Esophageal distension or spasm from a large bolus or temperature change can produce retrosternal chest pain that mimics angina. This is why a patient who reports chest pain after consuming a large meal or after drinking very hot or cold beverages points toward a GI source, rather than heart, lung, or orthostatic causes. In contrast, pain worsened with exertion suggests ischemia, dizziness on standing points to orthostasis, and a frequent productive cough suggests a pulmonary process.