Tag Archives: angina

“Listen to your patient – he’ll give you the diagnosis” Sir William Osler A pivotal moment in clinical decision-making arises when patients presenting with typical – or indeed atypical – symptoms of angina receive noninvasive testing results indicating no evidence of obstructive CAD. This apparent discordance between the patient’s reported experience and the objective findings often presents a diagnostic dilemma. It is in our nature (and training) to question the subjective – the accuracy of the clinician’s initial assessment, the authenticity, or relevance, of the patient’s reported symptoms. This is especially likely if

Introduction Undifferentiated chest pain places a significant burden on the UK National Health Service (NHS). Up to 50% of the general population experiences chest pain in their lifetime contributing to at least 1% of GP consultations and 5% of accident and emergency (A&E) attendances.1 Chest pain patients have a twofold higher mortality versus age-matched asymptomatic controls.1 One reason is undiagnosed obstructive coronary artery disease (CAD), which has effective treatments to prolong life and improve symptoms.1 The challenge is identifying the patients at greatest risk, providing a timely diagnosis and starting effective treatment. T

Dear Sirs, Statistical probabilistic reasoning is important in understanding the likelihood of ‘false-positive’ (FP) and ‘false negative’ (FN) results when requesting any diagnostic test. In cohorts with a low prevalence of disease, a significant number of positive results are likely to be FP. Conversely, when the disease has high prevalence, FN results increase. Identification of patients with suspected coronary artery disease (CAD) relies on clinical history, examination and electrocardiogram (ECG)/laboratory results. The National Institute for Health and Care Excellence (NICE) define angina as “typical” or “atypical” depend

Introduction Approximately 4.2 million people (7.5% of population), whose racial origins are from South Asia, live in the UK. High rates of coronary disease in Asians,1-4 seem likely to be influenced by genetic factors.5 We have previously reported differences in the presentation of coronary syndromes between British South Asians, as a whole, and white Europeans.6 The term ‘South Asian’ describes around 1.5 billion people (22.5% of the world’s population), occupying regions as diverse as Sri Lanka to Nepal. A wide variety of genotypes, cultures, diets, belief systems, educational attainment, socioeconomic status and risk factors are enc

Coronary heart disease is responsible for one sixth of UK deaths. Improvements in making an earlier diagnosis and more effective management have aided a reduction in mortality over the last two decades. Such improvements would not have been possible without well thought-out and carefully constructed guidance and teaching programmes. With the spread of internet technology, online medical education has seen an exponential growth in popularity. The British Journal of Cardiology (BJC) has recently launched its e-learning site BJC Learning and its first e-learning programme on angina (www.bjcardio.co.uk/learning). The angina e-learning programme

Introduction Angina is the most common presentation of coronary heart disease (CHD).1 Effective treatment requires appropriate medical care, but also patient participation in lifestyle changes and medication concordance. Patient understanding of their disease and its treatment is desirable to enhance patient participation. Angina may be treated with medication only, through percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Although there are some circumstances where there is a preferred treatment option, research increasingly shows that in many situations the different treatment options for angina have similar

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Lessons Both patients and doctors can learn from this study. Patients need to be better informed about the natural history of coronary heart disease and what can be done to try to alter it – that is control not cure. Patients also need to understand the limitations of pharmaceutical agents and what revascularisation strategies can realistically achieve in the short and long term. In particular, over-optimistic pre-operative expectations1 need to be tempered with a dose of reality – the TV soaps and tabloid newspapers and magazines may be partly responsible – but more detailed explanation prior to intervention would not go amiss. Doctors

Prevention In the opening session on prevention strategies, Dr Brendan Lloyd, Medical Director, Cardiff Local Health Board commented that these must be carefully chosen based on the evidence and focused towards those most likely to show the most benefit, ie. higher risk patients. However, as Dr Phil Webb, All Wales Specialist Commissioner of Cardiothoracic Services pointed out, without an appreciation of the spectrum of decisions that influence healthcare managers, clinicians cannot begin to understand their reasoning. Dr Terry McCormack, a Whitby GP and PCCS Chairman, showed that, according to national statistics, coronary heart disease (CHD