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LETTERS: David S Coulshed, Guy D Eslick, Nicholas J Talley, and Graeme M Mackenzie Non-cardiac chest pain BMJ 2002; 324: 915 [Full text]

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"Non-anginal" is preferable to "unexplained origin" in describing non-cardiac chest pain

Sundaram V Ramanan   (24 April 2002)

"Non-anginal" is preferable to "unexplained origin" in describing non-cardiac chest pain 24 April 2002
Sundaram V Ramanan, Professor of Medicine St. Francis Hospital, 1000 Asylum Avenue Suite #1002, Hartford CT 06105-1299, U.S.A. Send response to journal: Re: "Non-anginal" is preferable to "unexplained origin" in describing non-cardiac chest pain	Editor: I agree with Coulshed et al (BMJ 13 April 2002, p. 324) that providing the patient with a diagnosis is extremely important in allaying apprehension relating to the presenting symptom. I am however less certain that “chest pain of unexplained origin” will satisfy most patients. Admitting that one does not know, is an increasing trend in medicine, and well it should be. Benign monoclonal gammopathy was the term used to describe an M spike in a plasma protein electrophoresis when it was an isolated observation without other features of multiple myeloma. This was not satisfactory, for some patients with this abnormality did progress to myeloma. The next phase in nomenclature was non-myelomatous gammopathy, also an unsatisfactory term, as it suggested the definitive absence of multiple myeloma. The term monoclocal gammopathy of undetermined significance (MGUS) introduced by Robert Kyle from the Mayo Clinic is in current usage. Although cumbersome, it is closest to the truth. Several similar examples exist. “Chest pain of unexplained origin” may not calm a patient’s anxiety, for the possibility of a cardiac cause of pain remains. “Non-cardiac chest pain” is also unsatisfactory unless one can make this diagnosis with absolute certainty. I do not have a good suggestion, but “non-anginal chest pain” to which may be added “with a normal electrocardiogram” if this is applicable is a thought. We have here a disorder that seeks a diagnostic label. Perhaps readers of the BMJ can come up with other ideas. Sundaram V Ramanan, Professor of Clinical Medicine University of Connecticut School of Medicine sramanan@stfranciscare.org