Journal of the Hong Kong College of Cardiology

Volume 10 Number 2, April 2002

Atypical Chest Pain: The Modern Dilemma of Chest Pain Despite Normal Coronary Anatomy

Eugene B Wu, Chu-pak lau*

From Cardiology Division, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, *Cardiology Division, University Department of Medicine, Queen Mary Hospital, Hong Kong

WU AND LAU: Atypical Chest Pain: The Modern Dilemma of Chest Pain Despite Normal Coronary Anatomy. Atypical chest pain is a common problem with substantial morbidity and an increasing prevalence, partially driven by our anxiety over legal peril. A normal coronary angiogram is a suboptimal outcome for the patient as it entrenches the idea of disease and often fails to reassure the patient. There is an urgent need to readjust our clinical practice to prevent normal coronary angiography by careful clinical history taking and selective non-invasive investigations of patients with chest pain. The chest pain score provides an excellent way to achieve the above aims. Once we have documented normal coronary angiography, we must strongly reassure the patient as well as offer an alternative diagnosis and treatment as appropriate and not leave these patients to fend for themselves, as many of them face unemployment and continuing pain if left untreated. Hypertension, postmenopausal pain, panic attacks, oesophageal reflux, and anxiety neurosis should be identified and dealt with to minimize the morbidity of these patients. (J HK Coll Cardiol 2002;10:88-93)

Key words : Atypical pain, chest pain, defensive medicine, normal coronary, syndrome X

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