The most frequent cause of chest pain among primary care patients is chest wall syndrome, Swiss researchers report in the online journal BMC Family Practice.

The most frequent cause of chest pain among primary care patients is chest wall syndrome, Swiss researchers report in the online journal BMC Family Practice.

Among 24,620 consultations at 58 private practices over a five-week period, "we observed 672 cases of chest pain and 300 (44.6 per cent) patients had a diagnosis of chest wall syndrome," report Dr. Francois Verdon from the University of Lausanne and colleagues.

Chest wall syndrome affected all ages and both sexes equally, according to the team. In their experience, history and sensibility to palpation are the keys to making an accurate diagnosis.

"As chest wall syndrome lacks biological or imaging markers, the diagnosis stands on clinical symptoms of which none is specific, but a clustering of predictors led to a more precise picture," Dr. Verdon told Reuters Health.

Pain, the researcher explained, is generally well localized on the chest wall, often on the left or median-left part of the chest wall. The pain is "not squeezing nor oppressive and not exercise-induced, but influenced by mechanical factors as a movement or a body position, and is reproducible by palpation."

The etiology of chest wall syndrome is usually ill-defined. "However, it may be caused by or be associated with long-lasting cough or dyspnea, thoracotomy, diverse rheumatic or spine disorders, fibromyalgia and anxiety," Dr. Verdon said.

Although chest wall syndrome is benign, "it tends to recur and causes real anxiety and frequently suggests to the patient the possibility of heart disease," Dr. Verdon noted.

In the current series, chest wall syndrome co-existed with heart disease in only 19 cases and with neoplasm in six patients.

"To give a precise diagnosis of chest wall syndrome is important," Dr. Verdon advised, "and clear diagnosis of chest wall syndrome is reassuring in comparison of just ruling out a serious disease without a precise diagnosis."

• BMC Family Practice 2007, 8:51. Published under BioMed Central's Open Access license agreement.