Noncardiac (Unexplained) Chest Pain

Noncardiac (unexplained) chest pain may be caused by esophageal disorders, psychiatric problems, or visceral hypersensitivity of unknown etiology. The most treatable etiologies, in order of their frequency, include gastroesophageal reflux disease (GERD), panic disorders, visceral hypersensitivity (ie, the irritable esophagus), and achalasia. Ensure the diagnosis is correct, and exclude important cardiac disease. In the younger patient, this may require an EKG, stress test, and echocardiogram, while older patients will need coronary angiography. Reassure the patient that there is no evidence of serious disease, and discuss the prognosis.