1. Dtsch Med Wochenschr. 2015 Jul;140(15):1166-1172. Epub 2015 Jul 31.

[Differential diagnosis "non - cardiac chest pain"].

[Article in German]

Frieling T(1).

Author information: 
(1)Innere Medizin/Klinik II, Helios Klinikum Krefeld.

Non cardiac chest pain (NCCP) are recurrent angina pectoris like pain without
evidence of coronary heart diesease in conventional diagnostic evaluation. The
prevalence of NCCP is up to 70 % and may be detected in this order at all levels 
of the medical health care system (general practitioner, emergency department,
chest pain unit, coronary care). Reduction of quality of life in NCCP is
comparable, partially even higher compared to cardiac chest pain. Reasons for
psychological strain are symptom recurrence in app. 50 %, nonspecific diagnosis
with resulting uncertainty and insufficient integration of other medical
disciplines in diagnostic work-up. Managing of patients with NCCP has to be
interdisciplinary because non cardiac causes of chest pain may be found
frequently. This are musculosceletal in app. 40 %, gastrointestinal in app. 20 %,
psychiatric in app. 10 % and pulmonary and mediastinal diseases in app. 5 % of
cases. Also gastroenterological expertise is required because here
gastroesophageal reflux disease (GERD) in app. 60 %, hypercontractile esophageal 
motility disorders with nutcracker, jackhammer esophagus or distal esophageal
spasmus or achalasia in app. 20 % and other esophageal alterations (e. g.
infectious esophageal inflammation, drug-induced ulcer, rings, webs, eosinophilic
esophagits) in app. 30 % of cases may be detected as cause of chest pain may.
This implicates that regular interdisciplinary round wards and interdisciplinary 
management of chest pain units are mandatory.

© Georg Thieme Verlag KG Stuttgart · New York.

PMID: 26230070  [PubMed - as supplied by publisher]