|
Heart Conditions Without Pain Are Deadly
Heart Patients With No Pain Get Worse Hospital
Treatment
By
Daniel DeNoon
Reviewed By Brunilda Nazario, MD
on Friday, August 06, 2004
WebMD Medical News
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.
--------------------------------------------------------------------------------
SOURCES: Brieger, D. Chest, August 2004; vol 126:
pp 461-469. News release, American College of
Chest Physicians.
|
