We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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


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

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also 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.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
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.


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

4 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

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

Articles Related By Topic
PubMed Articles