A DIAGNOSTIC AUDIT OF PATIENTS REFERRED TO CARDIOLOGY DEPARTMENT WITH NON-CARDIAC CHEST PAIN & BENIGN PALPITATIONS AT LIAQUAT UNIVERSITY HOSPITAL, HYDERABAD

Objective To carry out a diagnostic audit of patients referred to the cardiology department complaining of chest pain and palpitations with special focus on the complaints that are non-cardiac and benign in nature. This shall serve to identify the burden on the cardiology department. Methodology The single center study is conducted at a tertiary hospital (Liaquat University Hospital) receiving new referrals from a health district (Hyderabad) and carried out jointly by the department of cardiology and the department of medicine unit II. 94 consecutive referrals by OPD and/or COD to the cardiology department and then to the medical unit II (on Tuesdays during June 2016) with the presenting disorder of chest pain or palpitations were assessed at first attendance (research interview, doctors' ratings, accounts of medical history and ECG). Results 39 patients were given a cardiac diagnosis and 51 patients were not given a cardiac diagnosis. The non-cardiac group was more likely to be young women, and to report other physical symptoms and previous psychiatric problems. Conclusion The results show that a majority of the patients referred to the cardiology department did not eventually have a cardiac issue and consequently add to the patient load presenting at the department. The non-cardiac patients do pre-occupy the hospital staff and add to the delay in health care received by genuinely cardiac patients. The non-cardiac patients (ones with other major physical diagnoses) also suffer due to patients with functional symptoms owing to stress and anxiety. A mechanism needs to be implemented to make this process efficient. Furthermore the concept of considering non-cardiac chest pain and benign palpitations as less important and taking them less seriously should be shunned. Even though these complaints have a lesser mortality but a morbidity that matches its counterpart. Patients experiencing the symptoms regard their pain as very important and a physician should give them their due importance by treating them just as urgently as any other disease. Effective methods of pain relief too should be available at hand for the physician so as to give the patient instant relief. Recommendations ECG facilities should be available at the OPD and COD departments to quickly rule out cardiac issues so as to prevent sending the patients to useless trips different departments. Key words: Chest pain, Palpitations, Benign palpitations, Non-cardiac chest pain and Hospital burden.