NONCARDIAC CHEST PAIN - WHERE DOES IT START

The pathogenesis of recurrent noncardiac chest pain remains an enigma. The literature suggests that it may be caused by a heightened state o f visceral nociperception. Coronary atherosclerosis must first be excl uded with a reasonable degree of certainty. The physician can then foc us on reassuring the patient and continuing management, bearing in min d the caveat, first do no harm. Polypharmacy and hazardous procedures should be avoided. Aggressive acid suppression is helpful in patients with gastroesophageal reflux disease, and antidepressants have shown p romise in otherwise unexplained cases of chest pain. Despite significa nt morbidity in patients with the disorder, the long-term prognosis is excellent.