By K. P. Ball MD, FRCP, J. Fleming MD, FRCP, T. J. Fowler DM, FRCP, Ian James MB, PhD, FRCP, Geoffrey Maidment MB, MRCP, C. Ward MD, MRCP (auth.)
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However, perhaps further accumulation of cholesterol in the intima of the THE PATIENT WITH CHEST PAIN 61 coronary arteries may be prevented. There is no clear evidence that a reduction in size of cholesterol plaques in the coronary arteries is brought about by cholesterol-lowering regimes, and clinical trials have not yet provided convincing proof of any effect on prognosis. Nevertheless, most clinicians agree that treatment is desirable for any identified lipid disorder, the vigour with which the treatment is pursued depending on the patient's individual circumstances.
Breathlessness accompanies the pain but is not the dominant symptom. The amount of exertion undertaken before the occurrence of pain is not always constant and it is not unusual for a man to experience pain walking to work in the morning and thereafter to perform quite heavy physical work without further discomfort. It is the relationship of chest pain to exertion which is the most crucial feature in reaching the diagnosis of angina pectoris. 1 HANDBOOK OF CARDIAC CARE Typical distribution of pain in angina pectoris nature of the pain is not so important: patients describe it variously as vice-like, burning, heavy or like toothache and some patients are unable to give an adequate description at all.
Many of us occasionally receive detailed reports from private medical insurance schemes which some firms offer as a service to their employees. Furthermore, an increasing number of patients are requesting a routine examination 'just to make sure ... '. The discovery of an abnormality under these circumstances inevitably raises several questions. (1) Is the unexpected finding due to disease or is it a normal variant? (2) If it is abnormal, what action, if any, should be taken? It is fair to say that almost any type of heart disease may occasionally be detected in an asymptomatic patient.