What happens at the appointment
A/Prof Verjans takes a detailed history of the pain: where it is, what brings it on, how long it lasts and what relieves it. Pain that comes on with exertion and settles with rest is the pattern most suggestive of a narrowed coronary artery. He then examines you, records an ECG in the rooms and reviews your risk factors, medicines and previous results.
Tests that may follow
- CT coronary angiogram: the preferred test for most people with new chest pain and no known coronary disease, because it shows plaque directly. Performed on photon-counting CT at SAHMRI.
- Stress echocardiogram: for people who cannot have contrast or whose arteries are already known to be calcified.
- Echocardiogram to check valves and pumping function, and Holter monitoring if palpitations accompany the pain.
- Blood tests for cholesterol, diabetes and kidney function, usually collected at Clinpath in the same building.
Possible causes
Besides coronary artery disease, chest pain can come from the heart lining (pericarditis), the aorta, the lungs, the oesophagus and stomach, the chest wall muscles and joints, or anxiety. Part of the assessment is confidently ruling the heart in or out so that other causes can be treated by your GP.
After the assessment
You leave with a clear explanation of the likely cause and a plan. If coronary plaque is found, treatment usually starts with cholesterol-lowering medication, blood pressure control and lifestyle changes; a minority of patients need a stent or surgery. Your GP receives a letter after each visit.