Unexplained (non-cardiac) chest pain.

Non-cardiac chest pain is considered to be central chest pain that resembles angina yet, after appropriate investigation, its cause appears unrelated to the heart. The problem is common: one in four of the population have at least one episode over the course of a year and patients with chest pain account for about 5% of all presentations to primary care physicians and emergency departments.1 Even among those patients referred for coronary angiography, a significant proportion has no evidence of ischaemic heart disease (IHD). The terminology can be confusing and, because of the possibility that such pain may still result from thus far unrecognised cardiac disease, the term ‘unexplained chest pain’ (UCP) is preferred to the more usual ‘non-cardiac chest pain’ and certainly preferable to the vague term ‘atypical chest pain’. When IHD has been excluded, the prognosis for these patients is usually excellent.2 However, despite the potentially beneficial effect of reassurance resulting from negative investigations, many such individuals continue to experience symptoms, seek medical advice and accrue considerable healthcare costs.1