Heart attack patients who do not have chest pains are three times as likely to die, probably because doctors do not recognize their symptoms, researchers reported.

An estimated 13 percent of patients without chest pain died in the hospital, compared to 4.3 percent of patients with chest pain, according to the study published in the journal Chest.

The patients who died tended to be older women, the international team of researchers found.

"While the majority of people who have acute coronary syndromes, such as heart attacks and unstable angina, feel chest pain, some do not, but, instead, may experience atypical symptoms of fainting, shortness of breath, excessive sweating, or nausea and vomiting" said David Brieger of Concord Hospital in Sydney, Australia, who led the study.

Patients without chest pain tended to be older women with diabetes, heart failure or high blood pressure. Patients who suffered chest pain were more likely to be smokers with clogged arteries.

"Often, when a patient arrives at the hospital without chest pain, it is only after blood test results come back or other diagnoses are excluded that the physician reassesses the situation and determines it is an acute cardiac event after all," Brieger said in a statement.

"We hope that our findings will remind physicians that these events do occur in the absence of chest pain and will prompt them to make the diagnoses and institute the appropriate treatment more rapidly."

Brieger and colleagues studied the cases of more than 20,000 patients from 14 countries including the United States, Canada, Australia, Great Britain, and France.

Reference Source 101
August 10, 2004

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