0
Editor's Correspondence |

Empiric Therapy for Noncardiac Chest Pain

David E. Langdon, MD
Arch Intern Med. 2000;160(21):3331. doi:.
Text Size: A A A
Published online

Extract

Angiographically normal persons, usually women, who suffer often severe heart-type pain have long frustrated cardiologists. As Borzecki and colleagues noted,1 gastroenterologists have comprehensively studied noncardiac chest pain (NCCP). Such studies, besides being expensive, invasive, and nontherapeutic, have resulted in findings that have correlated poorly with pain episodes. My experience with NCCP dates back to 1964. Disgruntled, a dozen years ago, I switched to trials of varied therapies, avoiding most inquisitions. In my community practice, in contrast to Borzecki and colleagues' model, NCCP too often is not helped by today's vogue treatment: acid suppression. Although Borzecki and coworkers considered and cited other less documented options,1 they ended up offering too little, only that! To me, irrespective of "infallible" cardiac studies, safety dictates beginning treatment not with acid suppressives, but with vasodilators. Even if sublingual nitroglycerin therapy fails, my cookbook favors dilatory calcium channel blockers, which may be of benefit in at least 20% of cases! Costs and timing in diagnostic and therapeutic trials are pain and frequency dependent: more often, equals faster decisions.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 4

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();