Explaining the diagnosis of functional cardiac disorders
| Task | Example |
|---|---|
| Find out what the patient thinks the symptoms mean and what their concerns are | Are you able to tell me what you think is causing your symptoms? Is there anything that particularly worries you? |
| Ascertain how symptoms have previously been explained, including in unhelpful ways | Who else have you seen for these symptoms? How have other healthcare professionals explained your symptoms? What did you take away from their explanations? I'm sorry you have sometimes gone away feeling that your symptoms weren't thought to be important. What I want to do today is to explore what you think is going on and how some of the assessment we have done can help us to come to a diagnosis. |
| Explain initial differential diagnosis | There are many different causes of chest pain including acid reflux, narrowed blood vessels around your heart and, quite often, your body's physical response to stress. Are these things that you have thought about before? Are there any other diagnoses you have thought might be causing your symptoms? |
| Explain findings of history, examination and investigations | Your examination and investigations have shown me that your heart structure is healthy and working well, which is reassuring as heart disease is not the cause of your symptoms. Do these tests make sense to you? |
| State that these make a diagnosis of a functional cardiac disorder rather than one of the other diagnoses and why | Your description of these symptoms and our investigation findings suggest you have what we call a functional cardiac disorder: difficult and worrying symptoms without damage to or disease of your heart. Is this a diagnosis you have heard about before? |
| Emphasise that this is a real and recognised condition | This is a common and distressing problem that we don't fully understand but we do have treatments for. |
| Explain the functional disorder in terms of the interaction between the mind and body | We do not fully understand these conditions and suspect the causes are different in different people. We have a lot of evidence that some people experience psychological distress physically: rather than appearing as, say, depressed, they experience actual physical pain. Not knowing what this pain means and the anxiety that causes can lead to a cycle where it gets worse and really affects your life. Do you ever find that your symptoms change according to how you are feeling? |
| Consider giving an everyday example where the mind affects the circulatory system or drawing a diagram to illustrate the connections | The mind and the body affect each other a lot more than we realise. Blushing, for example, is a very physical response that can occur when we are embarrassed. When you are anxious or excited, your heart rate increases, and some people can even faint. |
| Create opportunity to explore psychosocial stressors | We don't fully understand what causes these problems and why they happen to some people. We do know that they seem to be more common in people who have gone through a difficult life event or who are under stress. I wondered if that resonates with you? |
| Explain that there are good treatments available and it is possible to make a good recovery | Are there any treatments that you had heard about or had been considering? There are good treatments available that focus on helping you understand and manage the symptoms. It is absolutely possible for you to make a good recovery and for these problems to stop impacting on your life. |