I had unstable angina and a quadruple bypass 16 years ago, so I was genuinely shocked when someone where I've been working went to a GP from work because she'd had a tight chest and (with no prior history of heart disease) returned with a practice nurse diagnosis of angina and a GTN prescription. She's in shock and doesn't believe the diagnosis ... and is scheduled to see a GP on Monday.
With my own history I tried to reassure her but the story doesn't sound right. I suggested that she went to A&E or called 111. She didnt want to call 999 which is the best advice for someone with chest pain. I am shocked that such a serious diagnosis can come from a practice nurse without reference to a Dr and fuller diagnostic checks. BP, pulse, O2 Sats and reported pain were all that seem to have been done. I really hope nothing serious happens over the weekend, and the lady gets better advice/help from her Dr.
Am I right to feel the disquiet I do? What would others do?
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Fish4Info
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Referring to yourself, is the quadruple bypass still working or has there been a deterioration in your condition over the years? If not, 16 years seems remarkable
As regards your colleague it comes down to whether a practice nurse can give such a serious diagnosis. I suppose that depends on their level of medical experience and how often they have had someone presenting themselves with this sort of condition. Obviously I can't know that. Has the person got someone at home who can keep an eye on them until Monday? The fact that neither of you believes the diagnosis suggests it might be better to err on the cautious side with at least a call to 111.
My bypass is still working! I am careful(ish) about what I eat ... but probably eat a little more than I should and don't do enough exercise. I'm still only 63 - but generally fit and well. My surgeon said he was hoping for a 35 year outcome (before any sort of redo). I'm hoping for longer! I think most of my personal fears for my colleague relate to my own journey: no symptoms (and feeling well etc.) to quad bypass in 4 weeks.
I'm not denying the diagnosis or the experience of the practice nurse. I think you have to go with the diagnosis unless or until it's proved otherwise. It just seems that this is a significant diagnosis ... which my colleague is very upset about and currently seems in denial of. Not taking the drugs she's been prescribed because of the denial could significantly increase risks to her.
There are quite a few steps to a proper diagnosis of angina ... e.g., troponin tests, exercise ecg and angiography. This is all hospital stuff. So turning someone out on a Friday afternoon with some GTN with a come back Monday message seems risky to me.
I'll jus keep fingers crossed: (1) that it isn't angina (she's young, or (2) if it is she gets proper help soon enough.
Firstly, angina is a symtom not an illness in itself. It can be caused by anxiety, without necessarily any serious cadio/vascular reason.
I first experienced angina (severe breathlessness ), while walking in Spain in heat. The second time I was at altitude in the Alps. Once home I quickly saw my GP who did an ECG then referred me to the hospital Cardio clinic . That appointment was about a month later. Only then did I see an "expert" who diagnosed unstable angina. It was another 3 months before I got an angiogram and a final diagnosis: "minor calcification no intervention necessary". Sent home with a Statin and aspirin . All that was in the good old days of 2017 when waiting lists were at least half as long as now.
I still get breathlessness but no pain. If I get any unusual pain I will go to A&E.
Obvs my colleague is on a diagnostic pathway. The main symptom of angina is chest pain. While it is not really the end-point of a diagnosis, it implies there is underlying heart disease. If the pain is brought on by exercise and goes away when you stop exercising, this is called stable angina. If the onset of pain is unpredictable and isn't associated with exercise, then this could be unstable angina, which is what I had and which is more serious. nhs.uk/conditions/angina/
I'm mainly anxious that my colleague may have this - from her descriptions to me - yet on Friday afternoon seemed to be in denial about the possibility of angina.
I think that angina is often used as a diagnosis when nothing else is obvious. My first A&E visit they told me they thought I was having a heart attack, but when troponin said otherwise said it was angina. One week later they used the same diagnosis as 2nd troponin test missed. Two days later they found atrial fibrillation. Your friend is possibly just at the start of their journey. By the way, did you know that a GTN spray can be purchased over the counter?
I should have stressed that if she has chest pain then ringing 999 is the appropriate action. 111 is another option, if they think it necessary they will arrange an ambulance.If paramedics attend they will do all checks including an ECG, BP, blood sugar, etc., and will only take her to hospital if it's they feel it's appropriate. Even as busy as they are they would much prefer people to call and it turns unnecessary than not to call when they really should.
I agree. Although I'd seen my GP and practice nurse in the preceding fortnight, I had horrible heartburn issues after a meal out with friends on 13/12/06. The Internet (Dr Google, I guess) said call 999. I didn't believe it so called 111. They did their questions and they called an ambulance! Long story short, 8 days later I had a CABGx4. I was only 47 with no previous history of heart disease etc. Obvs, I haven't told my colleague all this - cos I don't want to scare her. But it worries me that failing to use such an easy escalation is exposing my colleague to unnecessary risk. I don't really know her but I've tried to encourage her to 1) not to worry about her job (she is, and she has been told now to go home, but worries about losing pay) 2) get the drugs (gtn) she had a script for and 3) call 111 for further advice if she want to, before seeing the GP - as I know they'll call 999 if necessary.
I must admit that having been retired a good few years I tend to forget about work constraints and prescription charges. It does add on to the layers of concern.I know what you mean about the heartburn, all my episodes start with burning in my throat, just ever so slightly different to the acid reflux one.
I checked in Wikipedia it is P[harmony only] medicine and can only be sold if a registered pharmacist is on duty, and a trained person has asked questions to verify use. Depending on the answers, the pharmacist may have a duty not to sell the drug. So it seems it is available for OTC sale. It cannot be self-selected from the floor of the shop by a customer.
From my own history, I know that things rapidly escalated. I came within a gnat's pee of having a heart attack. V high troponin but not quite high enough.My own GP thought the issue had been stress and the 4 wire ECG didn't pick up the "ST depression indicative of ischaemia" - a phrase I'll remember for the rest of my life.
For me, chest pain means hospital or 999, and don't bother with the GP unless it's concerned with the management of a diagnosed condition.
I’m just glad someone has been cautious enough to help this lady as women are often dismissed as anxiety rather than heart issue. And it’s great she can benefit from your experience. I think but not sure but angina is an event that happens as a result of an underlying problem, so hope the next step as Hidden said will be to look at any potential underlying issues. She has been lucky the nurse has acknowledged her and not dismissed. May turn out to be nothing fingers crossed but worth the check.
On the assumption that your colleague presented her condition to the nurse and the conclusion was it was not considered to be a medical emergency at the time I can understand the outcome being a prescription for a GTN spray to treat the symptoms of angina but not the cause, with a follow up appointment with the GP for Monday. However if your colleague's angina symptoms worsen in the meantime she is well advised to get down to A&E or call 999, especially if the chest pains do not go way.
I believe that your friend was so anxious that she has probably missed at least 50% of the information the nurse has given her.
Nurses with the ability to diagnose and prescribe drugs are trained to very high standards. Their basic training results in a university degree, therefore, I would not be concerned.
When she assessed your friend, the symptoms described must have sounded like a cardiac pattern.
The nurse is not making a diagnosis, she is covering all eventualities, one of them is the potential for angina.
The nurse has asked your friend to return on Monday to see the GP who will no doubt arrange further investigations.
It might not be angina but what if it was?
The GTN spray was no doubt prescribed just in case the pain was cardiac. The nurse would have more than likely, given full instructions on how and when to use it and what to do if there was no relief .
So, in answer to your question. I believe your friend was very lucky to have been assessed by a caring conscientious nurse.
If it turns out to be gastric origin, the GP will provide a prescription on Monday. However, if it turns out to be angina, that GTN spray might save her life!
I'm not sure I agree with everything you say. My colleague was definitely worried before she went to see the nurse and very upset when she returned to work.
I probably have a different POV about health care professionals because my observation is that they have many different skills, but don't know everything. I view them as stakeholders in our health and some are definitely better than others. My own comments about (unstable) angina are a result of lived experience and a scary operation (CABG×4) to relieve its symptoms. It's important to listen to the patients' voices.
Hi! Maybe ask the lady if her GP could refer her to the chest pain clinic at the hospital cardiology dept. I think that she would be thoroughly checked out there and hopefully get the answers that she needs. Like you I think it's bazaar that a regular GP could diagnose Angina without refering the lady to a specialist.
Thanks all. Since my worries of last weekend, my colleague has seen her GP and been urgently referred to the hospital cardiology dept for an ECG and other investigations. So she is 'now in the system' and 'on a journey' to discover what afflicts her. Luckily nothing happened to her last weekend. It's a shame that the referral process didn't start the moment the practice nurse suspected angina, but could only ask her to return to see a Dr after the weekend.
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