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Understanding Non-Cardiac Chest Pain: Causes, Diagnosis, and Management
Prevalence and Impact of Non-Cardiac Chest Pain
Non-cardiac chest pain (NCCP) is a common condition characterized by recurrent chest pain that mimics angina but lacks evidence of coronary heart disease upon diagnostic evaluation. The prevalence of NCCP is notably high, affecting up to 70% of individuals presenting with chest pain across various healthcare settings, including general practitioners, emergency departments, and specialized chest pain units. The impact of NCCP on quality of life is significant, often comparable to or even greater than that caused by cardiac chest pain, due to the recurrent nature of symptoms and the uncertainty surrounding diagnosis.
Psychological Factors and Panic Disorder
A substantial proportion of NCCP cases are linked to psychological factors, particularly panic disorder. Patients frequently present to emergency rooms with chest pain, fearing a heart attack, only to find that cardiac tests are negative. This pain is often a symptom of panic, accompanied by other panic-related symptoms. Misdiagnosis or delayed recognition of panic disorder can lead to increased healthcare costs and unnecessary use of resources. Effective management includes psychoeducational group therapy, which helps patients challenge faulty beliefs about their chest pain and learn strategies such as breathing retraining to reduce physical arousal and panic episodes .
Gastroesophageal Reflux Disease and Other Gastrointestinal Causes
Gastroesophageal reflux disease (GERD) is a leading cause of NCCP, accounting for 50-60% of cases. Other gastrointestinal causes include hypercontractile esophageal motility disorders, such as nutcracker esophagus, diffuse esophageal spasm, and achalasia, which contribute to 15-18% of NCCP cases. Additionally, various esophageal alterations, including infectious esophageal inflammation, drug-induced ulcers, and eosinophilic esophagitis, are responsible for 32-35% of cases. The multidisciplinary approach to managing NCCP is crucial, with gastroenterological expertise playing a significant role in diagnosing and treating these conditions.
Musculoskeletal and Other Etiologies
NCCP can also stem from musculoskeletal issues, psychiatric conditions other than panic disorder, and pulmonary causes. The heterogeneous nature of NCCP makes diagnosis challenging, as it requires distinguishing between these various underlying etiologies. Effective treatment hinges on accurately identifying the specific cause, although this is not always possible. Patients with ongoing NCCP and comorbidities often experience a decreased quality of life and continued healthcare utilization.
Conclusion
Non-cardiac chest pain is a multifaceted condition with significant implications for patients' quality of life and healthcare systems. Understanding the diverse causes, from psychological factors like panic disorder to gastrointestinal issues such as GERD, is essential for accurate diagnosis and effective management. A multidisciplinary approach, incorporating expertise from various medical disciplines, is vital in addressing the complex nature of NCCP and improving patient outcomes.
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