Abstract
Chest pain is one of the most common symptoms driving patients to a physician's office
or the hospital's emergency department. In approximately half of the cases, chest
pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease.
The other half is due to noncardiac causes, primarily esophageal disorder. Pain from
either origin may occur in the same patient. In addition, psychological and psychiatric
factors play a significant role in the perception and severity of the chest pain,
irrespective of its cause. Chest pain of ischemic cardiac disease is called angina pectoris. Stable angina may be the prelude of ischemic cardiac disease; and for this reason,
it is essential to ensure a correct diagnosis. In most cases, further testing, such
as exercise testing and angiography, should be considered. The more severe form of
chest pain, unstable angina, also requires a firm diagnosis because it indicates severe
coronary disease and is the earliest manifestation of acute myocardial infarction.
Once a diagnosis of stable or unstable angina is established, and if a decision is
made not to use invasive therapy, such as coronary bypass, percutaneous transluminal
coronary angioplasty, or stent insertion, effective medical treatment of associated
cardiac risk factors is a must. Acute myocardial infarction occurring after a diagnosis
of angina greatly increases the risk of subsequent death. Chest pain in women warrants
added attention because women underestimate their likelihood to have coronary heart
disease. A factor that complicates the clinical assessment of patients with chest
pain (both cardiac and noncardiac in origin) is the relatively common presence of
psychological and psychiatric conditions such as depression or panic disorder. These
factors have been found to cause or worsen chest pain; but unfortunately, they may
not be easily detected. Noncardiac chest pain represents the remaining half of all
cases of chest pain. Although there are a number of causes, gastroesophageal disorders
are by far the most prevalent, especially gastroesophageal reflux disease. Fortunately,
this disease can be diagnosed and treated effectively by proton-pump inhibitors. The
other types of non-gastroesophageal reflux disease–related noncardiac chest pain are
more difficult to diagnose and treat. In conclusion, the cause of chest pain must
be accurately diagnosed; and treatment must be pursued according to the cause, especially
if the cause is of cardiac origin.
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Article info
Footnotes
Publication of this article was supported by the Collège International de Recherche Servier (CIRS).
STATEMENT OF CONFLICT OF INTEREST: The author has nothing to disclose.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
