I enjoyed reading Dr Ali's commentary and of course, there is much truth in what he says.
Equally, the responses so far are equally valid, that there isn't always sufficient time to make a comprehensive diagnosis in hospital, troponin is a prognostic test and should always be considered in the light of patients symptoms and ECG changes. Part of being a doctor is dealing with diagnostic uncertainty and sometimes, we don't always come up with a unifying diagnosis. This is not to say the patient's pain is not real, but simply unexplainable. Often the best we can offer is to rule out serious and life-threatening disease, which is our overwhelming agenda, but not always that of the patient's. They will be reassured initially but left in pain and if the pain persists, may wonder "What is it then if not my heart?".
I would agree with Dr Ali that much symptomatology in secondary care, and possibly primary, has a psychological component but that is often more difficult to address with the patient who may be reluctant to consider such aetiology. If in doubt, revisit the history, as it is in there, where the diagnosis resides.
Rapid Response:
Re: “Troponin-negative chest pain”—a diagnostic evasion?
I enjoyed reading Dr Ali's commentary and of course, there is much truth in what he says.
Equally, the responses so far are equally valid, that there isn't always sufficient time to make a comprehensive diagnosis in hospital, troponin is a prognostic test and should always be considered in the light of patients symptoms and ECG changes. Part of being a doctor is dealing with diagnostic uncertainty and sometimes, we don't always come up with a unifying diagnosis. This is not to say the patient's pain is not real, but simply unexplainable. Often the best we can offer is to rule out serious and life-threatening disease, which is our overwhelming agenda, but not always that of the patient's. They will be reassured initially but left in pain and if the pain persists, may wonder "What is it then if not my heart?".
I would agree with Dr Ali that much symptomatology in secondary care, and possibly primary, has a psychological component but that is often more difficult to address with the patient who may be reluctant to consider such aetiology. If in doubt, revisit the history, as it is in there, where the diagnosis resides.
Competing interests: No competing interests