How Primary Care Doctors Misdiagnose Chest Pain

While it may seem natural to think of chest pain as a red flag for heart disease or heart attack, statistics reveal that chest pain symptoms are usually not a sign of serious impending illness. Chest pain is one of the most common complaints primary care doctors hear and they are faced with the dilemma of whether to act immediately or take a “wait and see” approach. New research, however, finds that doctors may actually misdiagnose up to 31.7 percent of patients as not having coronary heart disease (CHD) when they later are found to have CHD, instead diagnosing them with other heart ailments.

Doctors attempt to check for CHD or acute coronary syndrome (ACS) first, simply because these conditions can be dangerous and potentially fatal. But typically only eight to 15 percent of patients complaining of chest pain in a primary care setting are found to have CHD.  Most doctors continue to monitor a patient, take ECG readings and get the opinion of a cardiologist. A new study analyzed the accuracy of an initial diagnosis of chest pain with the actual number of those who were found to suffer from CHD.

In this diagnostic study, researchers evaluated the data from 1,249 patients over the age of 35 who reported chest pain to family doctors. They checked the doctors’ initial diagnosis for accuracy to determine whether patients were properly identified as having CHD. A total of 57 out of 180 patients were misdiagnosed by doctors as having myocarditis, cardiac arrhythmias, or other disorders rather than CHD.

Family doctors did, however, refer one in three of these patients given a false negative diagnosis to a cardiologist. Since physicians failed to identify cases of CHD in roughly 32 percent of the participants, there is an argument for considering a diagnosis of CHD with less profound symptoms. Yet researchers believe that if the “diagnostic threshold” was lowered, the result would be a dramatic rise in false positive diagnoses, in other words more people diagnosed with CHD who don’t actually have it. This quandary may be overcome by considering information from the patient’s history and physical exam rather than increasing the sensitivity of diagnosis.

While chest pain may not be a sign of impending heart attack, it’s always best to play it safe. If you experience chest pain accompanied by shortness of breath, weakness, or headaches, don’t hesitate to seek medical attention. A strand of hair may one day protect your life, until then…you may want to check out the latest research on how to keep your heart healthy.


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