Chest pain: Cardiac and non-cardiac causes

Angina pectoris is an early manifestation of coronary artery disease and requires urgent investigation to determine the cause. In individuals who experience chest pain and where the tests results for CAD are negative, a diagnosis of 'non-cardiac chest pain' is given. The outcome for these patients include being discharged home from hospital with no further planned follow-up, while other patients may be referred to specialties such as gastroenterology, respiratory and psychiatry for further diagnostic tests. This chapter will review the literature relating to the causes of non-cardiac chest pain and examine how the lack of a definitive diagnosis or a non-cardiac chest pain diagnosis affects the individual and can lead to significant healthcare utilization. The role of rapid access clinics and a multi-disciplinary approach to managing non-cardiac chest pain will be described. The presence of cardiovascular risk factors such as cigarette smoking, a diet high in saturated fats and low levels of physical activity should also be examined as many of these modifiable behavioural activities contribute to CAD and other co-morbidities. Recommendations that can be applied into clinical practice will be presented with an emphasis on reassuring patients, undertaking anxiety and depression screening and performing a cardiovascular risk assessment.