As is often the case, Mrs Patel, a 28 year old woman, presented with chest pain first to her general practitioner.1 Chest pain is a common presentation in general practice in all age groups, and often difficult to diagnose precisely. More often we attempt to exclude certain diagnoses—not only coronary heart disease but also pulmonary embolism, pneumonia, pneumothorax, and cancer. Most of these have been mentioned in the rapid responses.2

The case progression shows the difficulties that even cardiologists, with extensive hospital resources, have in reaching a clear diagnosis. For the general practitioner, things are even …