What should a patient with chest pain do?

So, Dr. Najjar, if you were to go to your general practitioner and complain of chest pain, what would their pathway be? Well, there's a number of different tests that a GP can organise if they are concerned that the chest pain is coming from the heart. In the United Kingdom, we're quite fortunate we have a network of what we call rapid access chest pain clinics that GPs can make an urgent referral to and And these clinics will risk stratify the patient based on the history of the pain that the patient's been having. If it sounds very cardiac, they will aim to see the patient in a very short period of time. If it sounds less likely to be related to the heart, then your appointment may be a bit further out. Once we see the patient, we would typically perform an electrocardiogram, or an ECG, sometimes known as EKG electrocardiogram, with a German spelling of the word cardio. We may also do a scan of the heart, using ultrasound technology, and that's called an echocardiogram, and in some centres we may do a running test or an exercise tolerance test, and that is a useful way of understanding how much a patient can do, but we understand that its sensitivity for diagnosing coronary artery disease or heart disease is modest. Those are the three basic tests. From these you make an understanding of what treatment that patient would potentially require? Absolutely, so in the modern era when we see a patient with chest pain we may want to do some definitive assessments and for example once I've done my initial assessment I may make some recommendations of medication or other treatments for the patient. If I believe that they have angina then I would typically start the patient on aspirin which is a blood thinning medication and I may start them on another drug that will control their heart rate, and there are a number of different drugs that do this, but the gold standard are beta blockers. These are drugs that slow down the heart and make the heart more relaxed and less likely to have the pain. We know that these drugs can be life-saving and in certain settings extend the years of your life many fold. Often patients need medications such as statins. These are medications that pacify cholesterol in the blood and calm down and the plaque that might be in an artery causing this problem. So these are three common medications that may be started. Another important one may also be a GTN spray or people refer to as nitro spray. This is often in a small red vial. This is a little red bottle that once opened has a life expectancy of about three months. And this spray is used under your tongue when the tightness in the chest comes on. And if the discomfort truly is angina, we typically find that the pain goes away very quickly. So that's a treatment, but also a way of understanding whether the symptoms truly are coming from the heart or not. Thank you very much.