Chest pain

doi:10.1136/bmj.b4117

Published 3 November 2009, doi:10.1136/bmj.b4117
Cite this as: BMJ 2009;339:b4117

Practice

Diagnosis in General Practice

Chest pain

Michael Jelinek, cardiologist and associate professor of medicine¹, Kevin Barraclough, general practitioner²

¹ St Vincent’s Hospital and University of Melbourne, Melbourne, Australia, ² Painswick GL6 6TY

Correspondence to: M Jelinek michael.jelinek@svhm.org.au

Having a sense of the accuracy of diagnostic tests will helpgeneral practitioners to interpret and use the tests appropriatelyand, as in the example of chest pain, avoid unnecessary testing(doi:10.1136/bmj.b3823)

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

A 45 year old man attends an emergency department having had10-15 minutes of severe retrosternal chest pain at a party earlierthat evening. The pain occurred at rest and resolved spontaneouslywhen he sat quietly. His electrocardiogram and troponin concentrationare normal on arrival at hospital and again eight hours later.He is discharged that night and advised to see his general practitionerthe next day for follow-up.

The likeliest cause of retrosternal pain in this patient isgastrointestinal. However, this presentation could be due tolethal coronary artery disease. The clinician needs to knowwhether the risk of coronary disease is low or whether the patientrequires further testing to clarify the probability of coronaryartery disease and the risk of cardiovascular death. An exerciseelectrocardiogram might refine the probability of disease andits prognosis.

Probabilistic (or bayesian) reasoning provides the frameworkwith which a clinician can track . . . [Full text of this article]

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