Painless Heart Attacks Pose Extra Risk

Doctors don't always diagnose those who don't report chest pain correctly

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HealthDay Reporter

MONDAY, Aug. 9, 2004 (HealthDayNews) -- A heart attack without chest pain may sound like a blessing, but a new study suggests the lack of the major symptom can steer doctors toward misdiagnosis.

Researchers found that cardiac patients who didn't report chest pains were three times more likely to die than their counterparts. They were also less likely to receive proper medication.

While it's true that the painless patients tend to be older and sicker, doctors still can do a better job of treating them, the study authors suggest in the August issue of Chest.

"More emphasis needs to be given to identifying and properly treating heart attacks in patients who do not exhibit typical symptoms," Dr. Richard S. Irwin, president of the American College of Chest Physicians, said in a statement.

The researchers analyzed the medical records of 20,881 hospitalized cardiac patients from 14 countries, including the United States, Canada, Australia and Great Britain. The patients suffered from heart attacks and other cardiac ailments.

About 8 percent didn't experience chest pain; 13 percent of those patients died in the hospital, compared to 4.3 percent of those with chest pain.

The researchers also found that almost a quarter of the patients without chest pain was initially misdiagnosed. Of those with typical symptoms, on the other hand, only about a tenth as many -- 2.4 percent -- were misdiagnosed.

Dr. Sean Deitch, an emergency room doctor at Scripps Memorial Hospital in San Diego, said physicians are becoming more aware that heart attack patients don't all show the same warning signs.

The study "is another reminder for us to focus" in on the differences, he said.

Why doesn't everyone feel chest pain during a heart attack? The answer lies in the sensory nerves around the heart, which can sometimes -- but not always -- become stimulated by the irritation of a heart attack, Deitch said.

The pain depends on the sensitivity of the nerves, the workings of the heart and the mechanics of the attack.

"Certain types of heart attacks can fool us," he said. "A person who has a poor blood supply to the bottom or back part of heart is less likely to experience chest pain symptoms."

Heart transplant patients may also not feel chest pain because the nerves around the heart aren't transplanted, he added.

In the new study, researchers found several groups were more likely to suffer cardiac problems without chest pain -- older women, diabetics and people with a history of heart failure or high blood pressure. Smokers with blocked arteries, on the other hand, were more likely to suffer from chest pain.

While physicians typically consider heart attacks when the elderly come in with suspicious symptoms, they can do a better job of diagnosing women, Deitch said. "Our real fault lies in the female population. We tend to think of (heart attacks) as more of a disease of men."

As for the general population, Deitch said people should remember that while chest pain is one symptom of a heart attack, there are many more.

"If they're experiencing other things like nausea, sweating and a sensation of almost passing out, or in fact passing out, they can all be warning signs of an impending heart attack," he added.

More information

To learn more about the warning signs of heart attacks, try the American Heart Association.

SOURCES: Sean Deitch, M.D., emergency room physician, Scripps Memorial Hospital, San Diego; August 2004 Chest

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