Advising patients on dealing with acute chest pain

doi:10.1136/bmj.39262.691343.47

BMJ 2007;335:3-4 (7 July), doi:10.1136/bmj.39262.691343.47

Editorials

Advising patients on dealing with acute chest pain

Instructions about using GTN and when to call an ambulance needto be clearer

The first 150 words of the full text of this article appear below.

How long people with chest pain should wait before calling anambulance is a question familiar to general practitioners andemergency doctors. The answer is complicated by the use of sublingualnitrate sprays, which promptly relieve the pain of stable angina.¹Ideally, patients would be able to distinguish stable anginafrom a potentially life threatening acute coronary syndrome,but in reality they do not. Therefore the decision about whento call an ambulance needs to balance between an overly cautiousstrategy that could overburden emergency medical services andone where delayed action leads to higher morbidity and mortality.The balance is difficult to find because international guidanceindicates that consensus has not been reached, even among cardiologists.²³ ⁴

The British Heart Foundation advises patients with known ischaemicheart disease that chest pain that lasts more than 15 minutesis probably a heart attack.² Within this time patients are advisedto use . . . [Full text of this article]

A Khavandi, cardiology specialist registrar, K Potts, cardiology nurse specialist, P R Walker, consultant cardiologist

Southmead Hospital, North Bristol NHS Teaching Trust, Bristol BS10 5NB

khavandi@hotmail.com