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At the heart of general practice since 1960

Chest Pain - advanced assessment and management skills

A revolution in chest pain management as spawned this handy guide, reviewed by Dr Arun Gadhok

A revolution in chest pain management as spawned this handy guide, reviewed by Dr Arun Gadhok

Since the National Service Framework for Coronary Heart Disease was published in 2000, there has been a revolution in the assessment and management of patients presenting with chest pain.

Rapid access chest pain clinics are universal, and the management of patients with myocardial infarction both out of hospital and in secondary care is much improved.

To provide this increased level of service, nurse and paramedic roles have been expanded, and it is to these practitioners I believe this book is aimed.

Appropriately the editors are from a nursing background, as are most of the contributors. However, GPs must also be expert at assessing patients presenting with chest pain, as it is the presenting symptom of many life-threatening illnesses.

The book is split into two sections, each comprising several chapters. Section 1 provides a framework. Initially the scene is set with a discussion about recent health care policy with regard to coronary heart disease.

The following chapters deal with history taking, examination and differential diagnosis. Section two is comprised of 10 chapters dealing with specific conditions which commonly present with chest pain ranging from acute coronary syndrome to herpes zoster.

The chapters are all laid out in the same systematic fashion, and each finishes with a table of key learning points.

The writing is clear and concise, and hence it is both easy and enjoyable to read. The book is also beautifully referenced. The descriptions of the symptoms and signs of how the various conditions present is largely evidence-based, which makes a refreshing change from the descriptions in the medical textbooks of old.

We learn that aortic dissection does not commonly present with a tearing back pain, and we are given a diagram comparing the pain radiation between the oesophagus and the heart.

However, the book is written largely from a secondary care perspective, with a lot of information about investigations and further management which would not be undertaken in primary care.

Worthy of particular mention is the chapter entitled ‘Analysing the presentation of women with chest pain'.

This looks at why older women have higher mortality rates from coronary heart disease than men, and at how clinical presentation can differ between the genders.

Did you know that the initial symptom in at least half of women with myocardial infarction can be shortness of breath? This chapter should be essential reading for all GPs, but I certainly learned from much of the rest of the book too.

Rating: 4/5

Dr Arun Gadhok


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