To the Editor.
—In the May issue (Arch Intern Med125:809, 1970) Drs. Burch and Giles add "Cardiac Causalgia" to a long list of syndromes, such as the anterior chest, pectoral, rib, and Tietze's, to describe nonanginal chest pains. The authors have apparently attempted to combine at least three distinct entities—psychogenic pain, the post-infarction syndrome, and the shoulder-hand syndrome—into a single symptom complex. They then divide this into major and minor variants, presumably based on the magnitude of the various components. They feel that the "causalgia" is associated with ischemic heart disease even though the pain is not anginal and does not have the distribution of anginal pain.The authors noted the emotional instability of their patients and observed that a great deal of attention and reassurance were helpful. Yet they seem reluctant to acknowledge the psychogenic factor which seems so prominent, especially in the "minor" group.Intensive study