Chest pain in people with normal coronary anatomy

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7325.1319 (Published 08 December 2001) Cite this as: BMJ 2001;323:1319

Addressing patients' fears is a priority

  1. Gurjinder Nijher, medical student,
  2. John Weinman, professor of health psychology,
  3. Christopher Bass, consultant in liaison psychiatry,
  4. John Chambers, reader in cardiology (johnchambers@dial.pipex.com)
  1. Cardiothoracic Centre, St Thomas's Hospital, London SE1 7EH

    Coronary angiography is often necessary for patients with chest pain, but 20% to 30% of examinations show normal anatomy.1 The use of angiography itself can contribute to symptoms in these patients, and non-organic factors are often overlooked. Providing a diagnosis may be less important than addressing a patient's concerns and fears.

    Potentially irrevocable changes in social circumstances may occur while a patient is on a long waiting list. The mean waiting time from the general practitioner's referral to angiography was 261 days in the United Kingdom in 1994 and about 60 days in Canada in 1993. 2 3 These delays provide ample time for adverse changes in lifestyle, work patterns or even losing a job, restriction in social and leisure activity, and disruption of family life. Such changes are directly related to time on the waiting list for coronary bypass …

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