Non-Cardiac Chest Pain

(Neurogastroenterol Motil 2006;18:408-17)

DEFINITION:

Chest pains of non-cardiac origin
Initial approach is to exclude coronary artery disease (CAD); Cardiac causes other than CAD: Mitral valve prolapse
See also Esophagus/Gastric- GERD (Chapter 1.14)

ETIOLOGIES:

Non Cardiac Chest Pain (cardiac excluded)
- DDX: GERD, Esophageal dysmotility, Musculoskeletal, Brain/Gut, Gallstones (rarely)
GERD: most frequent cause, up to 50% of unexplained chest pains
Esophageal dysmotility: up to 25-30% of unexplained chest pains (See below in order of frequency: highest to lowest)
- Hypertensive peristalsis/Nutcracker: most common manometric abnormality, high pressures during esophageal peristalsis
- Ineffective esophageal motility/Nonspecific esophageal dysmotility: weak or poor conducted waves
- Diffuse esophageal spasm
- Achalasia
Musculoskeletal (chostochondritis): remaining 20-30%
Psychological (Brain-gut) i.e. panic disorder, acting either independently or cofactors are responsible for many of these pain syndromes
More rare: biliary tract disease (gallstones)