Evaluation and management of patients with noncardiac chest pain

Area of Science:

• Cardiology
• Gastroenterology
• Psychology

Background:

• A significant portion of patients undergoing coronary angiography for angina-like chest pain exhibit normal coronary arteries.
• These patients often continue to seek medical attention, including emergency department visits, despite negative cardiac findings.

Purpose of the Study:

• To review the assessment and management strategies for patients with chest pain and normal coronary arteries.
• To highlight the potential shift in care from cardiology to gastroenterology for these patients once cardiac causes are ruled out.

Main Methods:

• This review synthesizes current evidence on the evaluation and treatment of chest pain with non-cardiac origins.
• It discusses pharmacotherapy and behavioral interventions.

Main Results:

• Normal coronary arteries are found in up to one-third of patients with angina-like chest pain.
• Gastrointestinal origins are increasingly recognized as a cause for such symptoms.
• Management involves a multimodal approach including education, reassurance, pharmacotherapy, and behavioral treatments for refractory cases.

Conclusions:

• Patients with chest pain and normal coronary arteries represent a distinct clinical group.
• Gastroenterological evaluation and management are crucial after excluding cardiac pathology.
• A combination of medical and behavioral therapies can effectively manage these challenging cases.