Humpty Dumpty

To the Editor:

Dr. Herbert L. Fred's editorial “Atypical Chest Pain: A Typical Humpty Dumpty Coinage”¹ in the October 2009 issue of the Texas Heart Institute Journal confronts a major problem in communication in cardiology: vagary and inaccurate thinking. He is absolutely right that “atypical chest pain” only confuses. In my experience, physicians who use this term have not thoughtfully considered the meaning and origin of the chest pain in question. I am personally delighted with Dr. Fred's editorial, which merits wide distribution, and I'm pleased that in my book on the diagnosis of chest pain² I have not mentioned the phrase “atypical chest pain,” nor is it in the index.

Albert J. Miller, MD
Professor of Clinical Medicine (Cardiology), Feinberg School of Medicine, Northwestern University, Evanston, Illinois