Some Chest Pains Require More Scrutiny in ER

Small percentage of patients go on to have heart attacks, problems a month later

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THURSDAY, Nov. 4, 2004 (HealthDayNews) -- Some people with chest pain should receive more thorough evaluation when they come to hospital emergency departments, says a Wake Forest University Baptist Medical Center study.

It found that 2.8 percent of people with chest pain who went to hospital emergency rooms and weren't diagnosed with heart problems had heart attacks or other heart-related events within a month. Another 3.5 percent had possible evidence of an adverse heart event.

"Not all chest pain is heart-related and, unfortunately, some patients whose pain is diagnosed as non-heart related end up having heart attacks," lead researcher Dr. Chadwick Miller said in a prepared statement.

"We wanted to know how frequently this happens and what characteristics these patients have in common that could help physicians in the difficult task of evaluating chest pain," Miller said.

He and his team identified a number of factors among people who were initially diagnosed with non-cardiac chest pain at a hospital emergency department and later suffered a heart event. These people were older than people who didn't have later cardiac events (61 years vs. 48 years) and were more likely to be men.

Other factors associated with later heart events were high cholesterol, diabetes, a history of heart vessel disease and a history of congestive heart failure.

"When the doctor's initial impression is non-cardiac chest pain, further evaluation should be considered if the patient has high-risk features such as a history of heart vessel disease, older age and high cholesterol," Miller said.

The study will appear in the December issue of the Annals of Emergency Medicine.

More information

The American Academy of Family Physicians has more about acute chest pain.

SOURCE: Wake Forest University Baptist Medical Center, news release, Oct. 29, 2004

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