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[ArchivalUser]

A 50-year-old man is evaluated for chronic, intermittent chest pain, unrelated to exertion. After being hospitalized 6 months ago with a suspected acute coronary syndrome for the same symptoms, a coronary catheterization showed normal coronary arteries. Subsequent testing for gastroesophageal disease was normal, and results of echocardiography and CT of the chest were unremarkable. He does not use cocaine. The patient continues to have chronic, daily, bothersome chest pain. Although he is anxious and distressed by his pain, he is not experiencing significant anxiety, stress, or episodes of overwhelming panic.

The physical examination is normal. Results of electrocardiography performed today are normal and are unchanged from his recent hospitalization.

Which of the following treatments has been shown to be helpful for this condition?

A Colchicine
B NSAIDs
C Tricyclic antidepressants
D Fluoxetine
E Tramadol

[ArchivalUser]

E Tramadol?

[ArchivalUser]

please take breakfast dear.

[ArchivalUser]

c....

[ArchivalUser]

Fluoxetine - SSRIs best for panic attacks, BZDs for acute therapy

[ArchivalUser]

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[ArchivalUser]

answer is CCC

This patient has noncardiac chest pain; therapy with a tricyclic antidepressant would be an appropriate option in this setting.

Although not rigorously defined, a current understanding of noncardiac chest pain is chest discomfort, the character of which is inconsistent with obstructive epicardial coronary artery disease, pericardial disease, or myocardial disease, or in which standard cardiovascular testing for such diseases has sufficiently ruled out the heart as a cause for the chest pain.

Among patients with chronic noncardiac chest pain, randomized, placebo-controlled studies have demonstrated that tricyclic antidepressants, β-blockers, ACE inhibitors, L-arginine, statins, and exercise may relieve symptoms. Empiric treatment with high-dose proton pump inhibitors may be helpful in diagnosing a gastroesophageal reflux etiology, and patients with esophageal spasm may respond to sublingual nitroglycerin or calcium channel blocker therapy.