A 40-year-old women presents with a 5-month history of episodic retrosternal pain that radiates to the interscapular region. The pain typically last for 15 minutes, precipitated by emotional stress and hot or cold food. She was given sublingual nitroglycerine tablet which alleviated the pain. Physical examination is normal. ECG and chest xray shows no abnormalties. What should be your next step?
- A. CT-Chest
- B. Esophageal motility studies (manometric recordings)
- C. Coronary angiogram
- D. Acid perfusion (Bernstein) test
- E. Pulmonary perfusion/ventilation scintigraphy
0 voters
Answer: B
Esophageal Motility study is the correct Answer
Description:
This patient’s symptoms are suggestive of diffuse esophageal spasm. Esophageal spasm is a motility disorder od esophagus and its diagnosed is confirmed by esophageal manometry.
The resolution of her chest pain after taking nitroglycerin is also consistent with the esophageal spasm because nitrates (or Ca channels blockers) relax not only the myocytes in the vessels but also those in the esophagus, thereby alleviating the pain.