Overview of functional chest pain
Functional chest pain describes recurrent retrosternal chest pain or discomfort occurring for at least 6 months in the absence of an identified cardiac, oesophageal or musculoskeletal cause. Symptoms may be very troublesome, with repeated visits to the emergency department and multiple investigations. Oesophageal causes can be difficult to diagnose—these include gastro-oesophageal reflux and distal oesophageal spasm.
Symptoms severe enough to require the patient to attend the emergency department require rapid evaluation (see Hospital management of acute chest pain of possible cardiac origin)—this is particularly important if the patient’s symptoms are not typical of their usual pattern.
A previous diagnosis of functional chest pain does not exclude ischaemic heart disease. However, once electrocardiogram and blood markers of ischaemia (and in some cases computed tomography [CT] or angiography) have excluded ischaemic heart disease as a cause of the chest pain, episodes can be managed symptomatically.