Chest pain--prophet of doom or nagging neurosis

A six month survey of 588 patients presenting with chest pain to our emergency room revealed some 85 different diagnoses. The most common ages were the sixties and there were more men than women. Myocardial infarction and reflux esophagitis were more common in men, esophageal spasm equally prevalent in both sexes and psychiatric disorders more common in women. Site, radiation, duration and description were helpful in presumptive diagnosis with a few surprises. The problem was common (3.7% of 15.716 visits to the Emergency Room) and frequently perplexing. Wrong diagnoses abound! An overview of the problem is presented including neural mechanisms in pain perception. Chest pain due to intrathoracic structures, the chest wall, nerve roots and extrathoracic structures are considered.