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An acute coronary syndrome with epigastric pain. A qualitative study about general practitioners Volume 13, issue 4, Avril 2017

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Authors
Département de médecine générale de Montpellier-Nîmes, Université de Montpellier, 641 av Gaston Giraud 34093 Montpellier cedex 5
* Tirés à part

In France, myocardial infarction affects 100,000 people a year. The 2003 FACT registry showed that in 36% of coronary syndromes, general practitioners are the first to provide care. 30% of acute coronary syndromes present atypical clinical symptoms such as epigastralgia. If general practitioners think of a coronary origin in epigastric pain, what are the limitations of their diagnostic approach and what about the possible paths for improvement?

In this study, general practitioners relied on clinical symptoms, context and electrocardiogram for acute coronary syndrome in atypical clinical manifestations, and in case of suspicion of acute coronary syndrome. But acute coronary syndrome of atypical presentation was a complex diagnosis for the general practitioners who were interviewed, due to the existence of differential diagnoses and risk-taking induced by providing care. The disengagement of the emergency sector from some general practitioners was due to the feeling of devaluation of their place as an actor of the emergency system associated with the fear of deadly errors. The general practitioners who were interviewed suggested possible improvements which should be evaluated.