Article

Seventy-four patients who underwent coronary arteriography during a 12-month period for evaluation of chest pain had normal coronary arteries and normal left ventricular function. Medical record review and interview data on the 58 patients who could be contacted were used to assess their status at a mean of 21.6 +/- 4.7 months after catheterization. The mean patient age was 50.2 +/- 10 years, 82% were black, and 64% were women. Ninety-one and four-tenths percent had some atypical characteristics of their chest pain ; however, a substernal location ; precipitation by exercise, emotion, or both ; and relief with rest or nitroglycerin was present in 82.O%, 68.9% and 67.2% of patients, respectively. Chest pain persisted after cardiac catheterization in 43 patients (74.1%). Thirty-five patients (60.3%) subsequently had a presumed etiology identified for the chest pain, but there was incomplete or no subsequent assessment in the remaining 23 (39.7%). Three of the 74 patients died during follow-up, but not due to a cardiac cause. Forty-seven patients (81.0%) remembered being told they had a normal heart after coronary angiography. Thirty-eight patients (65.5%) still believed they had heart disease ; ten of these did not recall being told of the normal findings at coronary arteriography. Twenty patients (46.5%) continued to visit emergency rooms or private physicians because of chest pain and 12 (20.6%) still used nitroglycerin to alleviate the discomfort. Sixty-eight percent of patients working at the time of coronary arteriography returned to work. Despite being told they have no heart disease, some patients fail to acknowledge this fact. We suggest : 1. Prompt diagnostic evaluation, including cardiac catheterization of chest pain syndromes, 2. development of a plan for further diagnostic evaluation after a negative coronary arteriogram to rule out common noncardiac causes of chest pain (where applicable), and 3. careful and repeated explanation of the normal cardiac status to the patient, with emphasis that there is no need for limitation of activity.

Langue : ANGLAIS

Identifiant basis : 1985102910