Doctor - patient conversation

A dialogue between a doctor and a patient

Doctor: What is bothering you?
Patient: I have chest pain.
Doctor: How long have you been feeling the pain? (Doctor asks because the pain can last from 2 to 5 minutes up to 15 and 20 minutes.)
Patient: I have been feeling pain for approximately 10 minutes.
Doctor: What’s the pain like?
Patient: My chest feels constricted, as if a heavy weight is upon my chest and I can’t breathe. (Patient motions with his hand on his chest as he describes the pain.)
Doctor: Only on your chest? Do you feel the pain expanding?
Patient: Yes, at times in my left shoulder down to my left arm, extending to my pinky and ring finger.
Doctor: Has this ever happened to you before?
Patient: Yes, it has.
Doctor: When does this happen most often?
Patient: When I walk fast this occurs, I have to stop and wait for the pain to subside.
(Doctor asks because pain is usually felt during physical exertion, experience of extreme emotion, during dental extractions, after eating large quantities of food (during digestion), forceful defecation etc etc)
Doctor: Have you taken any medication?
Patient: Yes, I have taken nitroglycerine.
Doctor: Does this relieve the pain?
Patient: After I take it, in a couple of minutes the pain subsides.

Patients who experience angina pain, are usually very agitated and anxious, at times pale, perspiration visible on the forehead, scared of potential imminent death.

At times, patient experiences problems with urination and defecation, sometimes urinating frequently or not at all.

During the examination

During the examination of the patient tachycardia (rapid) or extrasystoles (irregular) can be discerned. They could be suffering from high arterial blood pressure, but not very high values. Temperature is normal, no fever is usually observed.

Blood examinations such as leukocyte tests, erythrosedimentation tests, glycemic tests show no change in normal values, as opposed to a case of myocardic infarction.

Doctor is cautious when asking questions, in order to be able to have a thorough history of the disease when diagnosing the patient. Thus he asks about sudden, attack-like pain, the region over which the pain has spread, the conditions upon which the pain surfaced etc.

For this type of pain, nitroglycerine is extremely helpful, helping the pain subside in a matter of minutes, but in cases of different types of pain, this treatment would not be successful.

Doctor's diagnose

The doctor can thus run a differential diagnosis between an infarction of the myocardis, where pain is more severe and prolonged, and could occur regardless of physical exertion and nitroglycerine has no effect in soothing this pain, as well as heart neurosis. Pain in the aforementioned is shooting and could last from 5 minutes to entire days.

They surface based on the emotional condition of the patient, and the patient can actually point to where the pain is felt and not using their entire palm. It is most common amongst pubescent and menopausal women. Differential diagnosis is also run against tachycardia, pericarditis, different types of neurosis etc.

Mortality is very high, reaches up to 50%, and thus patients should be cautious and request medical assistance immediately. (It is absolutely necessary for these patients to acquire different machinery to individually control some of the basic parameters of the heart, such as oxymeters, manometers etc.)

Diagnosis is finalized after the performance of the EcG. If the EcG is run during one of the pain episodes, it shows the signs of ischemic disease. As the pain subsides, these signs disappear.

Medically Reviewed by a doctor on 24 Jan 2018
Medical Author: Dr. med. Diana Hysi