Saw GP twice last year with chest pain and advised it was muscular or gastric then on 21/1/22 went to AE with chest pain and angio found LAD 90% blocked. Got 1x stent fitted and started on 5 different medications inc Bisoprolol 2.5mg. Eventually got nurse to check bloods today(should have been done after 4 weeks not 14!) Heart rate was 43 bpm nurse said this was low but ok? Had to argue to get ECG which confirmed low rate and GP eventually agreed to lower dose of Bisoprolol. Really disappointed in lack of support and care from primary care practice and think I should change doctors but hear they're all the same?
Please dont ignore Chest Pain and is ... - British Heart Fou...
Please dont ignore Chest Pain and is GP system completely broken?
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Ambu96
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I agree with you. The GP will not act on your requests or suspicions but only on their own.
You did not say why you requested an ECG when your heart rate can be measured merely with your thumb on your wrist.
A HB of 43 is low but many of us live with it if it does not cause arrhythmias or fainting.
Maybe your GP won't but mine most definitely does.
And, do NOT use your thumb, because it has its own pulse that you may feel.
Of course you can use your thumb. It has the exact same pulse as your heart. Just don't use your thumb on someone else.
in reply to Palpman
I think what Sheldon meant is if you try and take any pulse at the wrist or carotid - yours or someone else’s - and use your thumb to do so, you can get inaccurate numbers due to the pulse in the thumb. Which is why medics always take your pulse with their fingers and the NHS specifically advise not to use your thumb on yourself or anyone else.
Palpman in reply to
Usually when people say "the thumb has a pulse of its own" what they mean is this: When you're taking someone else's pulse, you shouldn't use your thumb to take it because you might confuse your pulse for theirs.
However the pulse rate in the thumb is the same as in the other parts of the body.
in reply to Palpman
Ok. I’m not actually arguing with you. Just telling you what the current NHS advice is and how all first aiders have been trained to check pulse rate - for both themselves and others - by SJA for at least the last 15 years. The NHS are actually very explicit in saying don’t do it, not even on yourself:
nhs.uk/common-health-questi...
Palpman in reply to
The radial artery in the wrist on the thumb side splits into the fingers. The thumb has a single radial artery in the middle and the other fingers have 2 on the sides. They are all the same and the pulse originates from the ventricle.Yes, I was a medic for many years.
Palpman in reply to
👍
Good Morning,
Just to clarify, the NHS and BHF recommend that if you are to check your own pulse, or someone else's, you should follow the information that is found on their webpages. The pages clearly state that your index finger and middle finger should be used to avoid any confusion with your radial pulse and thumb pulse.
The Pulse check pages for each organisation are posted below for your convenience;
bhf.org.uk/informationsuppo...
nhs.uk/common-health-questi...
If you have any concerns about your or someone else's pulse, or wish to speak to someone about it, please do not hesitate to contact your GP practice, or contact the BHF Heart Helpline.
Thanks and have a lovely day 
Ruth (BHF Nurse)
👍
Hi Friend, I am so disappointed that these things happening in 21st century U.K. Honestly N.H.S has gone down even compared to U.S.A where medical care is not welfare based. Heart rate is low at 43 per minute. Putting it down to Bisoprolol is not enough. The bradycardia could be due to heart block -can be confirmed by ECG. Of course not to worry -it may temporary.
Here in England and Wales we have 2.9 doctors for every 1,000 people. That's the lowest ratio amongst the major European countries, where the average is 3.7, and the real standouts, like Austria, Germany and Norway are all at over 5.0 doctors per 1,000 people.
So let's train more doctors? But it takes seven year to train a doctor, and ten years to train a GP. Health Secretaries know they won't be in the job for more than a couple of years, so training up doctors and GP's is low on their priority list.
That's unforgivable, but what's even more unforgivable is that we have a unique piece of tax legislation in this country that means most doctors will see their pensions actually decline if they remain working past 60. That could be changed with a stroke of the chancellor's pen...but it won't happen. So we're hit with a double whammy, we lose experienced staff too early and we fail to train up their replacements.
But hey, we collectively voted for these people, so maybe we've nobody to blame but the great British public?
We also need more nurses, in particular Clinical Nurse Specialists and Advanced Nurse Practitioners in cardiology too! Then there are the many Allied Healthcare Professionals, also graduates as well performing our echocardiograms etc.
It takes much longer than 7 years to train as a Cardiologist.
After graduation there are several years as foundation doctors ( old school SHOs)
Then 7 to 8 years as a specialist trainee SpR ( old school registrar)
Some doctors take 3 years out to do a PhD.
So your average Consultant Cardiologist has trained more than 10 years.
Yes we really need more specialised nurses because it was a cardio nurse who picked out an unusual blimp in my final ecg which had not been identified before . She took two ecg’s “to be on the safe side” thank goodness . Don’t forget also that you see the same specialists when we go private as we do on the NHS and this must take up a lot of their time
Couldn’t agree more. Don’t know the numbers for Scotland where I live, but having experienced heart procedures in a provincial Austrian hospital, the care was superb.
Hello Ambu96, I’m so sorry you’ve had a poor experience with your GP. They are not all the same and I can’t praise my practice enough. After first attending last August with symptoms of breathlessness and fluid on the lung I was sent straight to cardiology for tests. GP arranged to ring me there after ecg for an update and arrange referral with cardiologist. After my meeting with cardiologist GP rang again.
Post mitral valve replacement surgery in March I was monitored by another GP at same practice who was incredibly empathetic and thorough and since she was leaving, she gave me the name of the GP who would take over my case. Having then had a TIA and attended A&E this new GP phoned me, and after my appointment with neurologist she phoned again. This is all at a busy London practice and I’m so grateful for the care they’ve shown. I’ve also taken to asking for print outs of all my results so I know I can share these should anything go amiss in the system!
If you see my previous posts they will tell you that I had your symptoms and diagnoses for 2 years because my t tests and ecg’s came back normal. I ended up with a triple bypass. All I can add is if YOU feel something isn’t right go to the person who specialises in heart disease or if you can’t afford it push for an appointment on the nhs.
Hi Ambu96,
Numbers, ratios, etc aside, there does seem to have been a change of attitude at my GP practice since a certain unmentionable illness appeared on the scene. I have received several texts asking me not to contact the practice as they were too busy. I cannot argue with this, but I ran my own Architects' practice for 25 years and never once sent any communication to my clients to say that I was too busy... such an action would be totally ludicrous in the commercial world. We just got our heads down and worked the extra hours required to meet the demands of the workload.
As to your personal situation, to some extent it mirrors my own. However, my experience was totally prior to the unmentionable illness. For years the rise in my blood pressure was dealt with, rather unsuccessfully, by medication. I ended up on two separate blood pressure medications and then had a heart attack which was caused by a blocked RCA. Had the cause been investigated I would not have had this happen. In my experience, GPs have always treated symptoms rather than causes. I should have been sent for an angiogram, but wasn't.
I had excellent care following my heart attack, with three separate hospitals involved. Once I was discharged to the care of my GP, things fell apart and have got decidedly worse. I cannot not now even get a blood test to monitor an hereditary condition, the response being that I am on medication to deal with it... yes, but am I on the correct dose? From experience, my cholesterol level rose and the dose of my statin had to be increased, so what is different with this matter? I am awaiting an answer.
I had to argue the case for my Bisoprolol to be lowered as at 3.75mg I was almost passing out when I stood up. I spoke to my GP and he said I ought to be on 10mg - I won't say what my reply was. I eventually got it reduced to 1.25mg after consulting the pharmacist at tge practice and even now my pulse can drop into the 40s when I am relaxed.
More and more I find that I am having to fight my own case with my GP. I don't want to change my GP practice, I want the GP practice to change! Am I asking to much?
Apologies for the rant, but I'm sure many have had a similar experience. I hope that the situation with your practice improves and you get the level of care that you need.
All the best,
Gerald
Do you really want to see a GP practice run in the same way as an architect's? Just put in the extra hours till the work is done? OK Mrs Jones we can offer you an appointment at 3.10 am. The health service has been underfunded for years, then on top of that changes were made that made the supply of medical personnel from Europe and abroad rather unwelcome. Then a pandemic hit, and despite what we are led to believe it has still not gone away. We are still getting more than 1500 deaths a week from that disease.
Medical staff are actually human beings, they can still catch and pass on disease. In fact as they are daily exposed to sick people, I should imagine they are at very high risk of doing so. Similarly, they come into contact with very vulnerable people and as caring humans they do not want to pass on potentially lethal diseases to their patients.My GP surgery have been advertising quite a bit recently for people to fill vacancies that have arisen, then this week they sent a text to all patients to let us know that due to staff sicknesses they are forced to reduce availability, but all appointments will be honoured. They also explained that by law anyone working in a health care situation on testing positive, must isolate for 10 days which exacerbates the staffing problem but is essential for the safety of their vulnerable patients. An architect's practice would not have that obligation would it?
While I agree with many of the comments that you have made, I can honestly assure you that I would never have invited any of my clients to a meeting at 3.10 a.m. and it is obvious that a GP would never do the same to a patient. That would be just ludicrous. However, I do feel that there is a case for extended hours to provide the appointments which patients obviously need, at least until the staffing shortfall can be addressed.
In the past 3 years since I have been passed back to the care of my GP, I have only once received a request for me to attend the local hospital to take a blood test. That was back in 2019. Since then I have had to remind the practice each year. I have never had any kind of check up, nor have I seen a GP or practice nurse. As I have said, I have had to be pro-active to get anything done... and that has even gone as far as suggesting changes to my medication.
Kristin1812Heart Star
I’ve had a lot of A and E visits to my small town DGH. Recently it has been noticeably busier, with ambulances queuing, staff very rushed and really very sick people. I was allocated one nurse, who was new that day, and had to be shown by a trained nurse where everything was.I paint the scene, because it seemed the care I received has been changing over the last few years.
I spoke to the Emergency Consultant (who I knew) who said ‘our job here is now just to make people safe’, and send them home asap. Just the basics for safety. The rest follows later.
People used to think it was a way of getting a test or Cons appointment or treatment quicker, but now, they just don’t have time for that, unless it would be unsafe to send them home, without it. Not with the huge increase in attendances, much sicker people, fewer staff, lack of equipment and diagnostics shortages, pressure to discharge, social care sadly lacking, sicker people attending, fewer in-patient beds for transfer, costs of investigations etc etc etc.
My view?
If we want an NHS that works better for us, we each need to add our voice, and speak up, to get it funded much much better. It’s our money paying for it, We need to train many more, attract staff back, pay people better, treat staff better, and invest much more in research, training, systems, buildings, new technology etc etc etc
in reply to Kristin1812
I totally agree about speaking out. I think there is an added pressure at most A & E departments across the UK. The GP’s are not seeing as many patients !! So people will go to the A&E nearest them
Why do they keep saying it is muscular or gastric!!!. You are about the 4th person i have heard of has been told this including my sister. It is only that i have been through this and ended up with a double bypass then later a stent. What is wrong with drs these days it just seems to me to be a shortcut to a diagnosis or they dont know their job. If i hadnt insisted my sister ask for this that and the other we would have lost her. Sloppy workmanship from drs !!!
Make that 5 then.The last cardiologist I saw about the suspected (as no one will properly diagnose) micro vascular disease I have, and I'm quite well medicated for, told me it was more likely to be indigestion. At that point, I stopped listening to him.
I was told the same spent 18 hrs in A&E they send a cardio nurse to see me he was not interested in what I had to say said It was 100% gastric no way was it to do with my condition CVD even though I have had 2 previous stents it now turns out 6 weeks later they suspect I have a blockage in my LAD after results of a echocardiogram I had 13 weeks ago only just got results after i had to ring loads of times to push for results so back in on May 10th for another angiogram - my GP did write to Cardiology in November 2021 for an urgent appointment which I never got ☹️
One thing I've noticed is how many doctors/nurses in the community are part time. In the medical centre I belong to, at last count, there were 53 staff, a good number of doctors, not one Dr was full time. The centre has a couple of paramedics employed for home visits to relieve some of the pressure.I've just waited 5 weeks 2 days for a face to face with my Dr, unacceptable.
Community nurses who were attached to the centre have now moved out and are further away, adding time to visits, so less calls, most are part time.
There are 2 community matrons, one for each side of the city. One works 3 days, the other works 4, but Thursdays are set aside for meetings and training, so another day lost for each one.
Then there's out of hours, nurses visit in pairs, there are only a couple of teams who cover a huge area of Devon., they are based 12 miles away from the city.
The service needs more money, more staff and total reorganisation.
Because a Dr is not full time in your practice, does not mean that they do not work elsewhere! A lot of them split their time between Primary & secondary care.
Similarly with some nurses, ANP's in my practice work part time in 2/3 different practices.
That doesn't help when the waiting time to see my Dr is over 5 weeks. As for the community nurses and community matrons, they don't work anywhere else.
I agree, but until someone magics more Dr’s the number of appointments available will not change.
As there are at least 11 partners at the centre, I don't think there's room for any more. At the last count, there were 53 staff, not including community nurses/matrons that are attached but located elsewhere, and 2 paramedics who do home visits from 8am onwards.
Then as with my practice, it sounds like the demand is far outweighing the supply, the numbers in my local practice (which they publish) are at levels never seen pre Covid, 35% of appointments are f2f, imagine if they where all f2f, the waiting times would sky rocket.
Not sure that anything will change in the short term, seems very few want to become a GP, can't say I blame them given the attitude of a lot the patients!
MilkfairyHeart Star
I diagnosed my husband's atrial fibrillation by taking his radial pulse with my two index fingers.
It's not just about the heartrate it's the strength and rhythm of the pulse that is important too.
My husband's AF was confirmed by an ECG at the GP's surgery.
I only use a NHS approved BP monitor and oximeter.
Many wearable devices can be unreliable.
4 years ago I had spent a whole year complaining to my GP about chest pain and breathlessness and being told it was muscular. I have degenerative disc disease level with my mid chest and several other skeletal problems that cause pain so I have to admit that a diagnosis was very difficult for him-- until I had a heart attack. Next time I saw him he grovelled with apologies. I was 70 at the time so he really should have considered heart and at least asked for my family history. ( Grandad was the only one of 13 siblings to pass 50 yrs old. Others all had heart disease ). However since them my treatment and check ups have been brilliant. I really don't blame him because my "normal" pain was so bad it was far too easy to blame that for everything. GPs are only human and are not experts. I now know to insist when I know a GP is wrong.
I had a HA and angioplasty last June.The discharge paperwork I was given clearly stated that I had to contact my surgery for blood tests four weeks after discharge.
My GP beat me to it and contacted me after my discharge to see how I was.
Since then I have had two further blood checks, all of which have been ok and a "healthy heart" appointment where a medicine usage review was conducted along with a lifestyle/diet discussion and BP taken.
Not all surgeries and GP's are the same.
I too went to see my GP regarding chest pains. She assured me, as I was suffering no other symptoms, it was likely gastric, and recommended Gaviscon. I am on Bisoprolol 10mg daily, and my pulse is around 42, when I mentioned it to the doctor, she just told me how an athlete would kill to have a pulse that low! I am not unduly concerned, even though I still get the occasional pain, because it's nothing new, and after I have taken some Gaviscon, all seems fine again. I do believe GP services have declined since the pandemic though, and look forward to the day a Health Secretary has the guts to really sort out the NHS! It's not a case of lack of funding, the billions of pounds pumped into the organisation this year alone is phenomenal!
Phenomenal, but insufficient. That 300+ million extra we were promised a few years back would help. Not making foreign especially EU medical staff unwelcome would help, actually building those 40 new hospitals we were promised would help, not privatising medical services so that the money flows into shareholders' pockets would help. Paying NHS staff more would help and would help attract people into the NHS both new recruits in training and trained staff from abroad. Yes, there are many things that could be done to help improve the NHS
PLEASE can we not make this thread Political!!!
I agree, but I was responding to a political type comment.
My experience is like others,
In 2016 I went to see my GP with chest pains and was told it was acid reflux. I had suffered with this before it was not the same.
Some weeks later I saw another GP who asked me what I thought it was and I said Angina (I was a diabetic) so the ball started rolling and this eventually ended up with a bypass in 2017.
I know we are all different but last year, probably September I had pains in my chest again, they were identical to the last time, in October after advice from my GP I presented at A & E and explained I had angina pain again. At some stage I was given Gaviscon, yes they had decided it was probably acid reflux. I stuck to my guns as I was 100% sure this was angina pain, IMHO once you've had it, it is I pain I won't forget.
A few days later I had 2 stents fitted via rotablation as there was a blockage in another artery.
I do understand how acid reflux/heart burn can initially be confused with Angina but I really think the medics should listen to the patient and take into account the medical history rather than look at things in isolation.
I too had a very similar experience with no follow up at all. Heart attack end of August 2020. I decided to change my GP and haven’t looked back. That said I do have to be pro active regarding checking my cholesterol levels as it seems to me Cardiologist doesn’t communicate with GP ? Personally I do believe GPS are not as busy as you imagine since Covid … the whole building where I stay is almost always empty of patients on any given day yet the Car Park is full to bursting … I had to park a good distance away on my last visit ???
Not all gp are the same, although reception staff can make a difference. Being regional Australia, we had real problems with actually having a doctor, until government put in incentives for some new doctors to be moved in. Now I can get an appointment sometimes even the same day, with my preferred gp. She is amazing, very thorough. But then you have the difficulty of diagnosis of heart problems. 1st time I had heart attack, ambulance officers did not think it was the heart, A&E didn't think it was the heart, let me wander around until troponin level showed it was. No family history of heart disease, fortunately the registrar, knew me, she was one of many that helped my husband who I nearly lost. The stress of that plus the fact I was diabetic made her insist that I be admitted to wait for angiogram and subsequent stents. Cardiologist said she saved my life. Even since that time in 2011, I am fortunate that most times cardiologist will listen that more action is needed. But I have been told it was muscular or reflux, I too suffer from chronic back problems. We don't all present with textbook symptoms, especially when you take gender in the mix. I couldn't imagine the mix of symptoms and problems the normal gp faces on a daily basis, especially when they are supposed to stick to a time limit. Let's face it, there are weird medical problems around. I for one, have trouble with explaining what I'm feeling, how I hate, rate your pain, totally useless if you live with chronic pain. Sorry for long post. Take care. Moni
I think it also depends upon how individuals symptoms present, my fiancé initially didn’t have any of the “typical signs” of heart problems.
Up until he had his bypass he’d never had anything other then a normal ECG, no high blood pressure or pulse etc. The first cardiologist he saw felt it was likely muscular from his symptoms, but sent him for a CT scan to make sure. That showed 3 severe blockages and he went onto have a triple bypass.
I guess at the end of the day, the only way a doctor can be sure of a diagnosis is after all the results of tests etc as doctors can only go on the symptoms displayed until more tests are done.
While I don't disagree with you I think the issue is that many GP's don't send you for the tests in the first instance.
My GP was quite happy to dismiss my chest and arm pains as the result of RSI in my shoulder. After 111 sent a paramedic he took an ECG and arranged an appointment with my GP the following day (something I couldn't get) for me to discuss his report. The GP rang to say her husband had Covid and repeated the original diagnosis on the phone. A month later, I ended up in hospital, after a 999 call and an inconclusive ECG, and a blood test confirmed I'd had a heart attack. Investigations showed I needed stents in both sides of the heart, due to inherited heart disease, not cholesterol.
It does seem very odd that so many GPs, when confronted with symptoms that could easily be heart related, seem to assume that they are not without any diagnostic test being done whatsoever. If this is through lack of training and knowledge it is poor. If it's through neglect it's even worse. Completely inexplicable why they do this.
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