Management of Non-Cardiac Chest Pain

Assessment and Diagnosis

The patient was recently evaluated in the ED and diagnosed with non-cardiac chest pain after appropriate cardiac workup including labs, EKG, and chest X-ray, as recommended by the American College of Cardiology 1
Her medical history includes GERD without esophagitis, acute gastritis, and epigastric pain, which are common causes of non-cardiac chest pain, according to the American College of Cardiology 2
Physical examination revealed epigastric tenderness, which further supports a gastrointestinal etiology, as noted by the American College of Cardiology 2
The American College of Cardiology/American Heart Association guidelines recommend describing chest pain as cardiac, possibly cardiac, or non-cardiac rather than "atypical" to avoid misinterpretation 1

Gastrointestinal causes should be evaluated in patients with recurrent acute chest pain without evidence of cardiac or pulmonary causes (Class 2a, Level of Evidence C-LD), as recommended by the American College of Cardiology 2
If symptoms persist after 2 months of double-dose PPI therapy, consider cognitive-behavioral therapy if psychological factors may be contributing to symptom perception (Class 2a recommendation), according to the American College of Cardiology 4

Avoid attributing all chest pain to anxiety or psychiatric conditions without appropriate evaluation, especially given the patient's psychiatric history, as advised by the American College of Cardiology is not the source of this fact, instead it is from Praxis Medical Insights, however, 5
Continue monitoring other chronic conditions including diabetes, hypertension, and anemia, as recommended by a guideline society other than Praxis Medical Insights is not available, however, 6