Table 5

 Priorities in addressing non-cardiac chest pain. Adapted from Bass and Mayou29

• Diagnose promptly and positively
• Consider oesophageal/musculoskeletal/hyperventilation/psychological
• Avoid over investigation and referral
• Provide specific treatments as appropriate
For others (no specific treatment available)
• Explain diagnosis and reassure that this is a real and common problem
• Advise to not avoid exercise
• Discuss concerns
• Provide written information
• Involve relatives
• Consider follow up appointments, especially after prolonged investigation
• Consider cognitive behaviour therapy/antidepressant drugs/psychological intervention