Aug. 9, 2004 - Heart patients without pain aren't lucky. They're at high risk of improper hospital care.
Severe chest pain is common in people who fall dangerously ill with what doctors call acute coronary syndrome -- usually blocked heart arteries, which cause heart attacks or angina. But 8.4% of these patients don't have pain. Instead, these patients may have shortness of breath, excess sweating, and nausea and vomiting.
Doctors often don't recognize how seriously ill these "atypical" patients are. As a result, they get worse care and are at high risk of death, report David Brieger, MD, PhD, of Concord Hospital in Sydney, Australia, and colleagues.
Brieger led a 14-nation study -- including the U.S. -- of patients who come to the hospital with acute coronary syndromes. The findings appear in the August issue of Chest.
The team's most striking finding: These atypical heart patients are more than twice as likely to die.
"Patients with acute coronary syndromes who present without chest pain are frequently misdiagnosed and undertreated," Brieger and colleagues conclude. "These patients experience greater morbidity and a higher mortality across the spectrum of acute coronary syndromes."
The researchers found that nearly one in four of the heart patients without chest pain got the wrong diagnosis. This happened to only 2.5% of patients with chest pain. Yet the atypical patients were much more likely to have signs of heart failure when they got to the hospital.
Silent or atypical heart disease is particularly common in patients with diabetes. Doctors are well aware of this fact. But more than two-thirds of those without chest pain as a symptom do not have diabetes, Brieger and colleagues found.
Patients with acute [blockage of the heart arteries] in the absence of chest pain are older and sicker than those with chest pain," the researchers conclude. "The diagnosis is often made belatedly, and initial and subsequent hospital management is suboptimal. ... These patients represent a high-risk group."
Richard S. Irwin, MD, president of the American College of Chest Physicians, says this is a problem doctors and hospitals must fix.
"More emphasis needs to be given to identifying and properly treating heart attacks in patients who do not exhibit typical symptoms," he says in a news release.