When all of the tests are shown to be negative for myocardial infarction, Mr. Brown is given an antacid which completely relieved his pain.

Mr. Brown had reflux esophogitis, probably with esophageal spasm. The character and location of pain of esophogitis often cannot be differentiated from that of a myocardial infarction and esophageal pain will also respond to nitroglycerine. In addition, angina pectoris may not only follow exertion but also eating or emotional excitement.

In this case, the normal electrocardiogram during chest pain and negative cardiac enzymes make a myocardial infarction unlikely. The response to antacids is helpful in suggesting gastroesophageal reflux as the cause of Mr. Brown's pain.

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