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Editor's Correspondence
November 27, 2000

Empiric Therapy for Noncardiac Chest Pain

Arch Intern Med. 2000;160(21):3331. doi:

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.

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