Chest pain not in the textbook

Medical schools teach future doctors the typical characteristics of angina. In practice, however, patients may not present with these symptoms. GP researchers in London have studied how patients describe their pain, as part of a larger study of angina. A subsample of 64 patients already known to have, or were strongly suspected of having, coronary artery disease was interviewed.

While over half the patients said that they had a tight feeling in their chest, some patients described a sharp or stabbing pain. Some just complained of vague symptoms or discomfort.

Breathlessness was described by two-thirds of the patients. Some people put this down to respiratory problems. 

Patients sometimes attributed their symptoms to indigestion. Several people, including some who had experienced a myocardial infarction, underplayed the seriousness of their symptoms.

COMMENT

Clinical diagnosis of an ischaemic problem can be difficult, particularly in the elderly. Like patients, GPs may mistake angina for a gastro-oesophageal problem.

It is unusual for patients to give the textbook description of angina. Some have difficulty articulating what they feel and may use euphemisms. The study shows that characterising the pain is still a problem even in people who have already been diagnosed with heart disease. The fear of death may lead to denials that there is a problem.

As breathlessness was so common, perhaps it should be considered as one of the recognised features of angina.

Dr John Dowden, Canberra

Jones MM, et al. Patients’ descriptions of angina symptoms. Br J Gen Pract 2010;60:735-41