Shortness of breath may be a sign of heart attack and lead to less survival than those with typical symptoms of chest pain, according to a study.
The researchers from Braga Hospital in Portugal, showed that just 76 per cent of heart attack patients with dyspnoea or fatigue as their main symptom are alive at one year compared to 94 per cent of those with chest pain as the predominant feature.
“Patients presenting with shortness of breath or fatigue had a worse prognosis than those with chest pain. They were less likely to be alive one year after their heart attack and also less likely to stay out of hospital for heart problems during that 12-month period,” said Dr. Paulo Medeiros from the Hospital.
“Dyspnoea and extreme tiredness were more common heart attack symptoms in women, older people and patients with other conditions such as high blood pressure, diabetes, kidney disease and lung disease,” Medeiros added.
Chest pain is the hallmark presentation of myocardial infarction but other complaints such as shortness of breath, upper abdominal or neck pain, or transient loss of consciousness (blackouts) may be the reason to attend the emergency department.
The study focused on non-ST-elevation myocardial infarction (NSTEMI), a type of heart attack in which an artery supplying blood to the heart becomes partially blocked.
The study included 4,726 patients aged 18 years and older admitted with NSTEMI between October 2010 and September 2019.
Patients were divided into three groups according to their main symptom at presentation. Chest pain was the most common presenting symptom (4,313 patients; 91 per cent), followed by dyspnoea/fatigue (332 patients; 7 per cent) and syncope (81 patients; 2 per cent). Syncope is a temporary loss of consciousness caused by a fall in blood pressure.
Patients with dyspnoea/fatigue were significantly older than those in the other two groups, with an average age of 75 years compared with 68 years in the chest pain group and 74 years in the syncope group.
Those with dyspnoea/fatigue were also more commonly women (42 per cent) compared to patients with chest pain as the main symptom (29 per cent women) or syncope (37 per cent women).
Compared to the other two groups, patients with dyspnoea/fatigue as their main symptom were more likely to also have high blood pressure, diabetes, chronic kidney disease and chronic obstructive pulmonary disease (COPD).
“This study highlights the need to consider a diagnosis of myocardial infarction even when the primary complaint is not chest pain. In addition to the classic heart attack symptom of chest pain, pressure, or heaviness radiating to one or both arms, the neck or jaw, people should seek urgent medical help if they experience prolonged shortness of breath,” Medeiros said.
- Harrison RN, Daly L (2011). A Nurse’s Survival Guide to Acute Medical Emergencies. Elsevier Health Sciences.
- “Congestive heart failure (CHF)”. Retrieved 12 November 2018.
- “Living Well With Chronic Heart Failure” (PDF). Heart Foundation. p. 18. Archived from the original (PDF) on 22 December 2014. Retrieved 25 May 2014.
- McMurray JJ, Pfeffer MA (2005). “Heart failure”. Lancet. 365 (9474): 1877–89. doi:10.1016/S0140-6736(05)66621-4. PMID 15924986. S2CID 38678826.
- Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. 23 (9): 1512–1517. doi:10.1093/ntr/ntab047. eISSN 1469-994X. LCCN 00244999. PMID 34213549. S2CID 235707832.
- “Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015”. Lancet. 388 (10053): 1545–1602.
- Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. (August 2016). “2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC).
- Developed with the special contribution of the Heart Failure Association (HFA) of the ESC” (PDF). European Journal of Heart Failure (Review). 18 (8): 891–975. doi:10.1002/ejhf.592. PMID 27207191. S2CID 221675744.
- Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. (2016). “2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)
- Developed with the special contribution of the Heart Failure Association (HFA) of the ESC”. Eur Heart J. 37 (27): 2129–2200. doi:10.1093/eurheartj/ehw128. PMID 27206819.
- “2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines”. Circulation. 128 (16): e240-327. doi:10.1161/CIR.0b013e31829e8776. PMID 23741058.
- McDonagh TA (2011). Oxford textbook of heart failure. Oxford: Oxford University Press. p. 3. ISBN 978-0-19-957772-9.
- O’Connor CM (2005). Managing Acute Decompensated Heart Failure a Clinician’s Guide to Diagnosis and Treatment. London: Informa Healthcare. p. 572. ISBN 978-0-203-42134-5.
- Willard & Spackman’s occupational therapy. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2014. p. 1124. ISBN 978-1-4511-1080-7.
- The Cardiac Care Unit Survival Guide. Lippincott Williams & Wilkins. 2012. p. 98. ISBN 978-1-4511-7746-6.
- (January 2019). “Exercise-based cardiac rehabilitation for adults with heart failure”. The Cochrane Database of Systematic Reviews. 1: CD003331. doi:10.1002/14651858.CD003331.pub5. PMC 6492482. PMID 30695817.
- Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. (September 2016). “2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America”. Circulation. 134 (13): e282–93. doi:10.1161/CIR.0000000000000435. PMID 27208050.
- ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. [corrected]”. Circulation. 126 (14): 1784–800. doi:10.1161/CIR.0b013e3182618569. PMID 22965336.
- Girerd N, Seronde MF, Coiro S, Chouihed T, Bilbault P, Braun F, et al. (2018). “Integrative Assessment of Congestion in Heart Failure Throughout the Patient Journey”. JACC Heart Fail. 6 (4): 273–285. doi:10.1016/j.jchf.2017.09.023. PMID 29226815.
- Thibodeau JT, Drazner MH (2018). “The Role of the Clinical Examination in Patients With Heart Failure”. JACC Heart Fail. 6 (7): 543–551. doi:10.1016/j.jchf.2018.04.005. PMID 29885957.
- Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association