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Review
. 2018 Apr;34(2):92-96.
doi: 10.1159/000486440. Epub 2018 Apr 12.

Non-Cardiac Chest Pain

Thomas Frieling  1
Affiliations
Review

Non-Cardiac Chest Pain

Thomas Frieling. Visc Med. 2018 Apr.

Abstract

Background: Non-cardiac chest pain (NCCP) is recurrent angina pectoris-like pain without evidence of coronary heart disease 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 due to NCCP is comparable, and partially even higher, to that caused by cardiac chest pain. Reasons for psychological strain are symptom recurrence in approximately 50%, nonspecific diagnosis with resulting uncertainty, and insufficient integration of other medical disciplines in the diagnostic workup.

Methods and results: The management of patients with chest pain has to be multidisciplinary because non-cardiac causes may be frequently encountered. Especially gastroenterological expertise is required since the cause of chest pain is gastroesophageal reflux disease (GERD) in 50-60%, hypercontractile esophageal motility disorders with nutcracker/jackhammer esophagus or diffuse esophageal spasm or achalasia in 15-18%, and other esophageal alterations (e.g., infectious esophageal inflammation, drug-induced ulcers, rings, webs, eosinophilic esophagitis) in 32-35%.

Conclusion: This review highlights the importance of regular interdisciplinary ward rounds and management of chest pain units.

Keywords: Achalasia; Distal esophageal spasm; Esophageal motility disorders; GERD; Gastroesophageal reflux; Jackhammer esophagus; Non-cardiac chest pain; Nutcracker esophagus.

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Figures

Fig. 1
Fig. 1
Esophageal motility disorder as a cause of non-cardiac chest pain (NCCP). From left to right: achalasia type I, achalasia type III, hypercontractile (‘jackhammer’) esophagus, distal diffuse esophageal spasm.
Fig. 2
Fig. 2
Esophageal ring (‘Schatzki ring’) at the cardiac region. Left: endoscopy, right: barium swallow, insert: bolus obstruction.
Fig. 3
Fig. 3
Eosinophilic esophagitis with mucosal edema, Tatami pattern, and irregular mucosa.
Fig. 4
Fig. 4
Diagnostic algorithm for the diagnosis of non-cardiac chest pain (NCCP) from the gastroenterological point of view (modified from [35]).
See this image and copyright information in PMC

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