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The Medical Literature
April 7, 1999

Users' Guides to the Medical Literature: XV. How to Use an Article About Disease Probability for Differential Diagnosis

Author Affiliations

Author Affiliations: Departments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Drs Guyatt, Cook, and Nishikawa); the Department of Ambulatory Care, Audie L. Murphy Memorial Veterans Hospital and the Department of Medicine, University of Texas Health Sciences Center at San Antonio (Dr Richardson); and the Department of Medicine, Bowman Gray School of Medicine and Wake Forest University Baptist Medical Center, Winston-Salem, NC (Dr Wilson). The original list of members (with affiliations) appears in the first article of this series (JAMA. 1993;270:2093-2095). A list of new members appears in the 10th article of the series (JAMA. 1996;275:1435-1439). The following members contributed to this article: Les Irwig, MBBCh, PhD; Virginia Moyer, MD, MPH; Thomas B. Newman, MD, MPH; David L. Sackett, MD, MSc; Jack Sinclair, MD; and John W. Williams, Jr, MD, MHS.


Users' Guides to the Medical Literature Section Editor: Drummond Rennie, MD, Deputy Editor (West), JAMA.

JAMA. 1999;281(13):1214-1219. doi:10.1001/jama.281.13.1214

You are an experienced clinician working at a hospital emergency department. One morning, a 33-year-old man presents with palpitations. He describes the new onset of episodes of fast, regular chest pounding, which come on gradually, last 1 to 2 minutes, and occur several times a day. He reports no relation of symptoms to activities and no change in exercise tolerance. He is very anxious and tells you he fears heart disease. He has no other symptoms, no personal or family history of heart disease, and takes no medications. His heart rate is 90 bpm and regular, and physical examination of his eyes, thyroid gland, lungs, and heart is normal. His 12-lead electrocardiogram is normal, without arrhythmia or signs of pre-excitation.

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