title: Chest pain: an update.
abstract: OBJECTIVE
  Chest pain is one of the most common symptoms for seeking acute medical care. Evidence of myocardial ischemia, however, can only be established in a minority of patients. The establishment or ruling out of myocardial ischemia is difficult and the cost is high. An effective rationale for ischemia detection, without unnecessary hospital admission, is needed. The development of chest pain units potentially offers a rapid, effective way of identifying patients at high risk for acute coronary syndromes, as well as those with a low probability of ischemia. Other cardiac or noncardiac causes of chest pain should also be considered.
  
  
  RESULTS
  Recent developments in chest pain, including the ruling in or out of ischemic pain by triage and different ischemia detection methods, are discussed. Other causes of chest pain such as esophageal, drug related, psychiatric and post-coronary bypass surgery pain are also discussed. Recent findings on syndrome X are reviewed and patients with myocardial infarction presenting without chest pain are discussed.
  
  
  CONCLUSIONS
  The possibility of safely and quickly ruling out myocardial ischemia by point-of-care biochemical analyses is reviewed, which might influence our clinical handling of chest pain patients. The importance of biopsychosocial factors, pain perception, esophageal dysfunction, drugs and the coronary artery bypass procedure in itself, is discussed and vital clinical information is provided for the handling of our chest pain patients.
authors.affiliation: Multidisciplinary Pain Center, Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden. mats.brjesson@telia.com
authors.forename: Mats
authors.initials: M
authors.lastname: Börjesson
authors.forename: Clas
authors.initials: C
authors.lastname: Mannheimer