Wrap Up

• Non-cardiac chest pain is usually a diagnosis by exclusion. This patient's physical examination and resting ECG were normal and a stress echo was entirely negative as expected.
• An empiric trial of anti-reflux therapy using a proton pump inhibitor was successful and further tests were not felt to be necessary.
• Distinguishing between cardiac and esophageal pain is very difficult at times. Factors which favor the esophagus include:
  • Pain persisting for over 20 minutes
  • Pain which occurs postprandially
  • Lack of radiation of pain
  • Associated esophageal symptoms (heart-burn, regurgitation, dysphagia)
  • Pain relieved by antacids
• Esophageal pain can mimic angina
  • It is often relieved by nitroglycerin
  • It can radiate to the arms and neck
  • It can be provoked by exercise (in patients who develop acid reflux with exercise)