• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. May 2003; 53(490): 378–382.
PMCID: PMC1314597

Chest pain and ischaemic heart disease in primary care.

Abstract

BACKGROUND: Chest pain is the main symptom of first presentation with ischaemic heart disease (IHD). Little is known about the incidence of IHD among patients consulting the general practitioner (GP) for chest pain. AIMS: To estimate the occurrence of IHD among patients consulting for chest pain, to study the results of the bicycle exercise test, and to estimate the incidence of IHD in the population. DESIGN OF STUDY: Prospective descriptive study. SETTING: Three primary health centres in south-eastern Sweden. METHOD: All patients without a current IHD diagnosis, aged 20 to 79 years, and consulting for a new episode of chest pain, were included consecutively. The outcome was classified as IHD, possible IHD or not IHD, according to the results of a postal questionnaire, an exercise test or hospital care. Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively. RESULTS: Out of 38,075 GP consultations, 577 (1.5%) were for chest pain. IHD was diagnosed in 41 (8%) of the chest pain patients, in 441 (83%) the diagnosis was excluded, and in 50 (9%) the diagnosis was judged as being uncertain. Even though the diagnostic criteria were strict, the exercise tests led to a diagnostic conclusion in 77% of the cases, most frequently a normal test result. Combining data from primary and hospital care, the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants (aged 20 to 79 years old). CONCLUSION: The incidence of a new episode of chest pain bringing the patients to the GP was low. Eight per cent of the patients received an IHD diagnosis, and in 9% further investigation or clinical assessment is needed.

Full Text

The Full Text of this article is available as a PDF (81K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Karlson BW, Herlitz J, Pettersson P, Ekvall HE, Hjalmarson A. Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. J Intern Med. 1991 Sep;230(3):251–258. [PubMed]
  • Karlson BW, Herlitz J, Wiklund O, Richter A, Hjalmarson A. Early prediction of acute myocardial infarction from clinical history, examination and electrocardiogram in the emergency room. Am J Cardiol. 1991 Jul 15;68(2):171–175. [PubMed]
  • Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network. J Fam Pract. 1994 Apr;38(4):345–352. [PubMed]
  • Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K. Chest pain in family practice. Diagnosis and long-term outcome in a community setting. Can Fam Physician. 1996 Jun;42:1122–1128. [PMC free article] [PubMed]
  • Buntinx F, Truyen J, Embrechts P, Moreel G, Peeters R. Chest pain: an evaluation of the initial diagnosis made by 25 Flemish general practitioners. Fam Pract. 1991 Jun;8(2):121–124. [PubMed]
  • Hedblad B, Juul-Möller S, Svensson K, Hanson BS, Isacsson SO, Janzon L, Lindell SE, Steen B, Johansson BW. Increased mortality in men with ST segment depression during 24 h ambulatory long-term ECG recording. Results from prospective population study 'Men born in 1914', from Malmö, Sweden. Eur Heart J. 1989 Feb;10(2):149–158. [PubMed]
  • Blacklock SM. The symptom of chest pain in family practice. J Fam Pract. 1977 Mar;4(3):429–433. [PubMed]
  • Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, McArthur D, Froelicher V. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989 Jul;80(1):87–98. [PubMed]
  • Ashley EA, Myers J, Froelicher V. Exercise testing in clinical medicine. Lancet. 2000 Nov 4;356(9241):1592–1597. [PubMed]
  • Slawson David C, Shaughnessy Allen F. Teaching information mastery: the case of baby Jeff and the importance of Bayes' theorem. Fam Med. 2002 Feb;34(2):140–142. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...