Introduction: Chest pain is responsible for up to 8% of all emergency department (ED) visits. It is a symptom of potentially harmful diseases including acute myocardial infarction (AMI). The aim of this study was to evaluate the prevalence of AMI and other causes of chest pain in repeated ED visitors with chest pain.

Method: We included patients presenting with chest pain to the ED of a tertiary referral hospital in 2015. Patients with ≥ 4 visits/ year for chest pain were considered repeated chest pain visitors. Patients with chest pain visiting the ED two or three times/year were defined as the control group.

Results: 128 consecutive patients with at least two ED visits due to chest pain were included. Of these, 12 patients qualified as repeated ED visitors and generated 59 visits in total. Median age was 50.3 years and 33.3% were female. None of the repeated visitors had an AMI. In 18.6% of these visits (11 of 59), chest pain was due to cardiac causes such as hypertensive crisis or cardiac arrhythmia.

Twenty-three patients of the control group (n=116) experienced an AMI (19.8%). Nineteen of these infarctions occurred during the index ED visit and only four during a secondary visit. Two of these four patients had a known history of cardiovascular disease and all four of them had received a negative ischemic work-up during their index visit.

Other frequent reasons for chest pain in ED visitors were psychosomatic (33.9%), musculoskeletal/rheumatological (28.8%) or gastrointestinal disorders (10.2%).

Conclusion: Even though in every fifth ED visit of repeated chest pain visitors a cardiac etiology was the cause of the chest pain, there was no AMI in this group. These findings might be helpful for diagnostic measures and treatment options in repeated chest pain visits in the ED.

Repeated emergency department users; Chest pain, Acute myocardial infarction