title: Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist.
abstract: Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers.
  
  
  
  We reviewed prior published work on (1) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP.
  
  
  
  We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions.
  
  
  
  Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population.
authors.affiliation: Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Kirsti A
authors.initials: KA
authors.lastname: Campbell
authors.affiliation: Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Madva
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Villegas
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Eleanor E
authors.initials: EE
authors.lastname: Beale
authors.affiliation: Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Beach
authors.affiliation: Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Ariana M
authors.initials: AM
authors.lastname: Albanese
authors.affiliation: Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA. Electronic address: jhuffman@partners.org.
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D001008:Anxiety Disorders / Q000150:complications / Q000175:diagnosis; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D016584:Panic Disorder / Q000150:complications / Q000175:diagnosis; D012017:Referral and Consultation; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis
keywords: cardiac; consultation psychiatry; disease management; non-cardiac chest pain; psychosomatic medicine