Chest Pain: Cardiac and Non-Cardiac

Abstract

Chest pain is generally interpreted as a symptom of cardiac dysfunction, usually myocardial ischemia, but the relationship of chest pain and ischemia is weak. Psychological states and traits (notably anxiety and depression) are strongly associated with chest pain in patients with known coronary artery disease both when measurable ischemia occurs and when ischemia cannot be concomitantly detected. Intense emotional arousal (anger and panic) is a known precipitant of symptomatic and asymptomatic (“silent”) ischemia. In addition to ischemiarelated chest pain, noncardiac chest pain is a common medical problem that is also associated with anxiety and depression. Treatment of emotional distress has been found to help diminish chest pain in both patients with cardiac and noncardiac chest pain and reduce ischemia in patients with coronary artery disease.