Mr Giles - chest pain

Question 1

Why did GTN work on this patient, who was presenting with:

1. Normal ECG
2. Patent coronary arteries
3. Non-radiating chest pain
4. Pain on swallowing (dysphagia)

Answer 1

The smooth muscle of the oesophagus responds to GTN

Question 2

Which of the following determines that this patient is not suffering with a cardiac issue?

1. Chest pain not worse on exertion
2. Chest pain doesn’t radiate
3. The pain is relieved by GTN

Answer 2

1 and 2

Question 3

What investigation could confirm oesophageal spasm?

Answer 3

manometry

Question 4

What two types of oesophageal spasm could be seen with manometry?

Answer 4

1. Corkscrew oesophagus

2. Nutcracker/hypertensive oesophagus

Question 5

Features of corkscrew oesophagus (3) contractions?

Answer 5

1. High amplitude
2. simultaneous
3. prolonged

Question 6

Features of hypertensive oesophagus (2) contractions?

Answer 6

1. abnormally strong peristaltic pressure

2. may be associated with a hypertensive LOS

Question 7

Treatment for oesophageal spasm (3)

Answer 7

1. Ca2+ channel blocker e.g. sublingual nifedipine
2. Alternatively, cont with GTN for symptomatic relief.
3. Identify + avoid foods that precipitate spasm