A thank-you to Dr. Moses for stressing the need for further clarification of the clinical application of the results accounted for in our article.
The results should not be interpreted as suggesting that every craniofacial pain patient should undergo an electrocardiogram (ECG). If the source of pain can be clearly identified (for example, dental or ear, nose and throat pathology) and diagnosed, clinical management should be directed toward curing the pathology.
If cardiac ischemia is suspected, the patient should be examined primarily with an ECG. At suspected acute myocardial infarction (AMI), the patient should be sent to the hospital for emergency care.
The clinician should be alert and consider cardiac ischemia or AMI when there is no obvious local source of the craniofacial pain, particularly when one or more of the following is the case:
- – The pain is triggered by physical stress (for example, walking up stairs), is of short duration and is spontaneously alleviated by rest. Cardiac ischemia should be considered.
- – The pain is persistent. AMI should be suspected.
- – The pain has a bilateral presentation. The projected pain of dental origin seldom crosses the midline.
- – The patient is female. Craniofacial pain as the sole symptom of cardiac ischemia or AMI was nearly 10 times more common in females than in males.
Furthermore, females are more likely to present with atypical ECG registrations.
We have just finished a study in which the character of craniofacial pain, which was induced by cardiac ischemia or AMI, is compared with the character of referred dental pain felt in the same regions. The results are aimed at further helping the clinician to determine the origin of craniofacial pain.
Another clinical implication is information to the public. In some countries, the public is well aware that chest pain and pain in the left arm are typical of cardiac ischemia. This implies a risk that a patient with only craniofacial pain will not seek emergency care, because the absence of chest pain and left arm pain in their mind means there is no cardiac problem.
