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ANGINA LIKE CHEST PAIN

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Many otherwise healthy patients continue to suffer from angina like chest pain even after the investigations for heart disease are normal. This recurrent chest pain in patients despite no apparent heart abnormality is not a new diagnosis. Physicians have been confronted with it for centuries.

The cause, despite extensive research continues to evade medical science. The relative significance of abnormalities seen in the coronary microcirculation, esophageal motility, acid reflux and psychological and psychiatric problems (panic disorder, anxiety disorder etc.) and mental stress need to be resolved. Recent studies implicate a heightened state of nociperception in the pathogenesis, angina, anxiety, and mental stress reflux.

The chest pain of GERD can feel like atypical or many a times typical angina or heart attack promting many patients to rush to the emergency room. Many a times, neither a patient or physician can distinguish the pain related to GERD from the heart attack. Remember, heart attack can kill, but not the GERD attack, so it is important not to jump to the conclusion that the pain is caused by acid reflux.

                                                         angina, anxiety, mental stress reflux

A cardiac etiology must always be excluded first to a reasonable degree of certainty. Once a life threatening cardiac etiology as been ruled out, we can focus on reassurance along with continued work up and treatment, bearing in mind -first do no harm. In particular, excessive drug therapy and potentially dangerous surgeries should be avoided. Aggressive stomach acid suppression is helpful in Gastro-esophageal Reflux Disease (GERD), while antidepressants (like imipramine) have shown promise in otherwise unexplained cases of chest pain.

Despite significant morbidity and health care cost, long term prognosis of patients with chest pain and normal coronary angiograms is excellent.

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ABOVE INFORMATION IS BASED ON AN ARTICLE BY DR. MINOCHA THAT APPEARED IN DECEMBER 1996 ISSUE OF POSTGRADUATE MEDICINE

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This article is meant to be an informational exercise and NOT a medical consultation. Your doctor is the only one who can best assess your situation and offer you medical advice

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