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As many as one-third of patients never
have chest pains prior to or during a heart attack, a study published
in The Journal of the American Medical Association suggests. And for
women, diabetics and others who belong to groups likely to have atypical
heart attack symptoms, more than half may never have such pains.
The report examined symptoms in more than 400,000
people who were treated for heart attacks in U.S. hospitals from 1994
to 1998. It found that patients who had no chest pains were more likely
to have delays in treatment and were less likely to receive lifesaving
therapies such as clot-busting drugs or the artery-clearing treatment
angioplasty. And they were more likely to die approximately one in
four patients without chest pains died during their heart attacks,
compared to one in 10 patients with chest pains.
"This is a landmark study, which shows that
if we continue to concentrate on chest pain, we are going to miss
an important number of patients," said study author John G. Canto,
MD. "We have known for some time that many patients have atypical
presentations, but we haven't known how many, who these patients are,
and what happens to them." Canto is director of the Chest Pain Center
at the University of Alabama at Birmingham.
In a written statement, American Heart Association
president Lynn Smaha, MD, Ph.D. calls the study "a wake-up call to
both the public and physicians."
"Chest pain is a symptom of a heart attack in many
cases, but many others have more unusual symptoms such as shortness
of breath, palpitations, dizziness, nausea, or fainting," Smaha says.
"The important thing to remember is that individuals need to pay close
attention to any unusual symptom they may be experiencing, and if
there is even the slightest chance they may be experiencing a heart
attack, they should call 911 and seek immediate medical attention."
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Chest pain is considered the hallmark symptom
of a heart attack, and has been the focus of efforts aimed at educating
the public about recognizing it. Canto says people must be made aware
that heart attacks often occur without this symptom, especially in
those who fall into one of six high-risk categories. It has long been
known that having diabetes is a risk factor for heart attack without
chest pain, but so is old age, female sex, prior heart failure, prior
stroke, and minority racial status, he says.
"If you have two of these risk factors, the chances that
you will have no chest pain during a heart attack increases to 50%
or greater," Canto says. "What we are hoping to do is to increase
awareness among these high-risk groups. So if, for example, you are
a woman with diabetes, you will talk to your doctor and understand
the atypical symptoms of heart attack."
Besides chest pains, symptoms that often accompany heart
attack include shortness of breath, pain in areas other than the chest,
severe indigestion, and severe sweating. But perhaps the most important
indicator of heart stress, Canto says, is a symptom that gets worse
with physical exertion.
"I can tell you that the symptoms that concern cardiologists
and other health care providers most are those that become worse when
you exert yourself," Canto says. "If, for example, you have indigestion
that gets worse when you walk and gets better when you stop, that
points to heart problems."
Ferris White has his own way of telling when things may
not be right his dog, Mack, is something of a canine barometer of
his master's health status.
"Any time I start getting sick he seems to know as soon
as I do," he says. "He's done it for both of my heart attacks. He
just starts licking me all over, and he jumps up on me, and looks
me right in the eyes. Then he goes and gets my wife, I guess to tell
her something is wrong."
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WebMD
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