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Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status
Insights
Many patients with chest pain and normal coronary arteries experience ongoing limitations in daily activities and work. Improved communication and rehabilitation may help these individuals, despite normal heart test results.
Area of Science:
- Cardiology
- Psychosomatic Medicine
Background:
- Chest pain is a common symptom prompting coronary arteriography.
- A significant subset of patients undergoing this procedure have normal coronary arteries and no diagnosed heart disease.
Purpose of the Study:
- To evaluate the functional status and persistent symptoms in patients with normal coronary arteriography.
- To assess the impact of a normal diagnosis on patients' perceived health and activity levels.
Main Methods:
- Prospective follow-up of 57 patients diagnosed with normal coronary arteries after catheterization.
- Assessment of activity limitations, work capacity, and belief in heart disease at a mean follow-up of 16 months.
- Comparison of pre- and post-catheterization functional status and medical facility utilization.
Main Results:
- At follow-up, 47% of patients reported activity limitations due to chest pain, and 51% were unable to work.
- Despite normal findings, 44% still believed they had heart disease.
- Medical facility use significantly decreased post-catheterization (P < 0.001).
Conclusions:
- Many patients with normal coronary arteries continue to experience significant functional limitations and psychological distress.
- A discrepancy exists between physician and patient perceptions of symptom improvement.
- Enhanced communication and targeted rehabilitation programs are recommended for this patient group.
Abstract:
Approximately 10 per cent of patients referred for coronary arteriography because of chest pain have angiographically normal coronary arteries and no other heart disease. We examined the functional status of 57 patients who had undergone catheterization (23 men and 34 women), all of whom were told that their hearts were normal, that their pain was noncardiac, and that no limitation on activity was necessary. At a mean follow-up time of 16 +/- 7.7 months, 27 of the 57 patients (47 per cent) still described their activity as limited by chest pain (before catheterization, 42 of 57 or 74 per cent); 29 of 57 (51 per cent) were unable to work (before catheterization, 36 of 57 or 63 per cent); and 25 of 57 (44 per cent) still believed that they had heart disease (before catheterization, 45 of 57 or 79 per cent). Use of medical facilities was significantly reduced after catheterization (P < 0.001). At follow-up the physician was more likely than the patient to believe that the symptoms had improved. We conclude that many of these patients remain limited in activity and may benefit from further efforts at comunication and rehabilitation.