People who have heart attacks or other heart conditions who do not experience chest pain are commonly overlooked and undertreated at the hospital, often resulting in greater fatality rates in this group of patients. A new study in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians, shows that cardiac patients presenting to the hospital without chest pain have triple the death rate of other cardiac patients and are less likely to receive medications to slow the progression of a heart attack.
“While the majority of people who have acute coronary syndromes, such as heart attacks and unstable angina, feel chest pain, some do not, but, instead, may experience atypical symptoms of fainting, shortness of breath, excessive sweating, or nausea and vomiting” said the study’s lead author, David Brieger, MBBS, PhD, Concord Hospital, Sydney, Australia. “Other than excessive sweating, each of the dominant symptoms of a heart attack not accompanied by chest pain independently identifies a population that is at increased risk of dying.”
A group of international researchers analyzed data from the Global Registry of Acute Coronary Events (GRACE), a registry of 20,881 patients from 14 countries, including the United States, Canada, Australia, Great Britain, and France. These patients were hospitalized with a variety of heart conditions from July 1999 to June 2002. Of the 1,763 cardiac patients who did not experience chest pain, 13 percent died in the hospital compared to 4.3 percent of those with chest pain. In addition, 23.8 percent of patients without chest pain were initially misdiagnosed when they arrived at the hospital, compared to only 2.4 percent of heart patients who experienced typical symptoms. Patients without chest pain tended to be older women and to have a history of diabetes, heart failure, or hypertension, as opposed to patients with chest pain who were more likely to be smokers with plaque buildup in their coronary arteries. Patients with atypical symptoms were also more likely to have the unfavorable outcomes of heart failure, cardiogenic shock, arrhythmias, and renal failure.
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