Document Detail


Limited value of the resting electrocardiogram in assessing patients with recent onset chest pain: lessons from a chest pain clinic.
MedLine Citation:
PMID:  1739527     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate a clinic set up specifically to assess patients with recent onset chest pain, particularly those presenting with a normal resting electrocardiogram. DESIGN: Retrospective review of case notes. SETTING: Cardiac department of a tertiary referral cardiothoracic centre. PATIENTS: 250 consecutive patients with recent onset chest pain seen within 24 hours of general practitioner referral. OUTCOME MEASURES: Clinical diagnosis and management. RESULTS: 40% of patients were seen within seven days of the onset of symptoms. Twenty seven per cent had non-cardiac symptoms and could be discharged while 60% were considered to have cardiac pain. Sixty six patients (26%) were admitted directly from the clinic and 48 of these underwent coronary angiography within three weeks. Seventy patients (28%) have so far undergone intervention (angioplasty or coronary artery surgery), 22 within one month of presentation. One hundred and nine patients (44%) presented with a normal resting electrocardiogram, 21 of whom were considered to have unstable angina. Forty one of these patients were investigated of whom 37 were found to have significant coronary disease and 26 have undergone intervention. CONCLUSIONS: This experience highlights the inadequacy of a routine electrocardiogram reporting service in patients with recent onset of chest pain. An alternative facility offering immediate and complete cardiac assessment produced patient benefit with early diagnosis and intervention. Investigation of these patients, however, accounted for 5% of cardiac catheterisation laboratory throughput; this was a significant additional and unscheduled workload.
Authors:
M Norell; D Lythall; G Coghlan; A Cheng; S Kushwaha; J Swan; C Ilsley; A Mitchell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British heart journal     Volume:  67     ISSN:  0007-0769     ISO Abbreviation:  Br Heart J     Publication Date:  1992 Jan 
Date Detail:
Created Date:  1992-03-25     Completed Date:  1992-03-25     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0370634     Medline TA:  Br Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  53-6     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Department, Harefield Hospital, Middlesex.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cardiac Care Facilities / utilization*
Chest Pain / etiology*
Coronary Angiography
Coronary Disease / diagnosis*
Electrocardiography / utilization*
England
Evaluation Studies as Topic
Exercise Test
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care) / statistics & numerical data*
Outpatient Clinics, Hospital / utilization*
Retrospective Studies
Comments/Corrections

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