Clinical Review ABC of psychological medicine

Chest pain

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7364.588 (Published 14 September 2002) Cite this as: BMJ 2002;325:588
  1. Christopher Bass,
  2. Richard Mayou

    Chest pain is one of the commonest reasons for consultation in primary care. Chest pain is usually mild and transient, but further management is required in some cases. These are of two main types—acute severe pain and persistent pain associated with distress and functional limitation. Acute central chest pain accounts for 20-30% of emergency medical admissions. Chronic chest pain is the commonest reason for referral to cardiac outpatient clinics.


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    British soldier admitted for observation with the diagnosis of “disordered action of the heart a post-combat syndrome in the first world war characterised by rapid heartbeat, shortness of breath, fatigue, and dizziness. (From Lewis T. The tolerance of physical exertion, as shown by soldiers suffering from so-called ‘irritable heart.’ BMJ 1918;i:363-5)

    Management of chest pain

    The improved diagnosis and early treatment of ischaemic heart disease have not been accompanied by similar advances either in the delivery of long term rehabilitation of patients with ischaemic heart disease or in the management of non-cardiac causes of chest pain. Since at least half of those referred to cardiac outpatient clinics and about two thirds of emergency admissions have a non-cardiac cause for their chest pain, there is a pressing need to address this problem.

    Primary care

    Primary care doctors have a major responsibility for the continuing care of patients with angina and those with chronic non-cardiac chest pain, as well as secondary prevention. They therefore need good communication with specialist cardiac services and access to appropriate resources, including psychological treatments.

    Patients with a low risk of coronary disease(such as young women with no cardiac risk factors and atypical pain) do not usually need cardiac investigation. Some, however, especially those with chest pain who have a family history of heart disease or other risk factors, may need investigation. In such cases it is important that the possibility of a non-cardiac …

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