For instance, the history is superior to stress tests, which frequently are positive when there is no disease and negative when there is. Furthermore, the physician who relies on tests is also misled by them. If an echocardiogram reveals a mitral-valve prolapse, that prolapse is immediately accepted as the cause of the chest pain. Yet we know that the association of mitral-valve prolapse and cardiac symptoms is questionable. In the highly regarded Framingham, Mass., study, a survey found no difference in the incidence of chest pain in comparable groups with and without mitral-valve prolpase.
Physicians also pursue the equally questionable hiatus hernia.
I have a hiatus hernia myself and know it can cause symptoms, but the pain is not brought on by effort and is readily distinguishable from that caused by heart and chest wall. So finding a hiatus hernia need not be the explanation of a patient's chest pain. There are two elements to a good history. The physician must ask the right questions. When this is done, the answer to whether the pain is coming from a barrel or from its contents can be established in short order.