Nigerian Quarterly Journal of Hospital Medicine

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Evaluation of Chest Pain in Ambulatory Patients in Lagos, Using the Rose Questionnaire and Resting Electrocardiogram

JNA Ajuluchukwu, AC Mbakwem


Purpose: Using the Rose Questionnaire, we aimed to study the characteristics of chronic chest pain in ambulatory care, to find patterns that are consistent with a diagnosis of angina pectoris.

Methods: Patients: Consecutive patients, referred to the Cardiac Out-patient clinic with a major complaint of chest pain of more than one month were included. Exclusion criteria consisted of the presence of congestive heart failure, or recent use of digitalis or beta blockers. The questionnaire for this study was that of the World Health Organisation Cardiovascular Survey/ Rose Questionnaire (RQ) with an additional section designed to obtain data on demography, and descriptive characteristics of chest pain. Angina was according to RQ definition. Health professionals trained in the use of the RQ, administered the instrument. Sub-group analysis was based on the presence and absence of angina.

Results: There were 214 patients, a male : female ratio of 0.8: 1; an average age of 44 years (age range of 16-70 years); 48% were obese (body mass index [BMI]>27 kg/m2) and 59% were over 40 years. The median duration of chest pain was six (6) months. Characteristic features of angina were present as follows: retrosternal location - 40%; pressure - like/constricting pain: 43%; and chest pain aggravated by exertion – 35%. Angina was diagnosed in 7%, whose pain stopped within 10 minutes of “stopping and resting”. Underlying diseases were hypertension-14.9%, Diabetes: 1%, and hypercholesterolaemia: 5.6%. Electrocardiographic (ECG ) abnormalities were common: left ventricular hypertrophy: 59%, ST elevation –25%, T wave inversion-6.5%. No ST depression was noted. Bundle branch block, prolonged PR interval axis deviation were found in less than 1%.

Age, sex, and BMI were comparable in those with and without angina. Features of chest pain without significant association with angina were location, character, duration of single episodes, and aggravation by emotion. However, aggravation by food and exertion distinguished the angina groups (p<0.05), but no ECG features did.

Discussion and conclusion: Prevalence of RQ – detected angina is 7%, indicating that a majority of patients with chronic chest pain had non-cardiac or atypical chest pain. Presence of underlying diseases, pain characteristics, or ECG features did not distinguish those with and without RQ - angina. Further studies are required to elucidate the causes, and prognosis of RQ- angina, in our environment.

Nig. Qt. J. Hosp. Med. Vol.12(1-4) 2002: 60-65
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