Difficulty Breathing More Ominous Than Chest Pain Among Patients With Myocardial Infarction

March 21, 2022

By Ed Susman

VIRTUAL -- March 21, 2022 -- A nationwide study of patients presenting to the hospital due to a possible myocardial infarction (MI) indicates that a patient complaining of shortness of breath may have a worse outcome than patients who have chest pain as their main symptom, according to a study presented at Acute CardioVascular Care 2022, a Scientific Congress of the European Society of Cardiology (ESC).

After 1 year, 76% of the patients who said that dyspnoea or fatigue was their main symptom were alive compared with 94% of those who told doctors that chest pain was their predominant symptom.

“Dyspnoea and extreme tiredness were more common MI symptoms in women, older people, and patients with other conditions such as high blood pressure, diabetes, kidney disease, and lung disease,” said Paulo Medeiros, MD, Braga Hospital, Brage, Portugal. “Shortness of breath was more common among patients that died during the year after their MI. However, when considering all of the studied variables, the type of presenting symptom was not an independent predictor of mortality, meaning that we cannot specifically state that shortness of breath was the reason for the worse outcome. Poorer survival may be due to other factors in those patients, such as reduced heart pump function.”

Predictors of mortality at 1 year were advanced age, chronic obstructive pulmonary disease, left ventricular fraction <50%,  and major bleeding.

The researchers analysed data from 4,726 adult patients from the Portuguese Registry of Acute Coronary Syndromes who were admitted to hospitals with a diagnosis of non-ST-elevation myocardial infarction between October 2010 and September 2019. About 71% of the patients were men and the average age of the cohort was 68 years. The researchers stratified the group by symptoms, with chest pain being the most common (91%), followed by dyspnoea/fatigue (7%), and syncope (2%).

Patients with dyspnoea/fatigue were significantly older than those who presented with chest pain (P < .001). They were also more likely to be female, and were more likely to have high blood pressure, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease.

During the year after their MI, 76% of patients in the dyspnoea/fatigue group avoided being hospitalised for a cardiovascular reason compared with 85% of the chest pain group and 83% of the syncope group.

“Patients presenting with shortness of breath or fatigue had a worse prognosis than those with chest pain,” said Dr. Medeiros. “They were less likely to be alive 1 year after their heart attack and also less likely to stay out of hospital for heart problems during that 12-month period.”

“This study highlights the need to consider a diagnosis of myocardial infarction even when the primary complaint is not chest pain,” he added. “This may be particularly important for women and older patients where diagnosis could be delayed and result in worse outcomes. 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.”

[Presentation title: Symptoms at NSTEMI Presentation - Do They Predict the Outcome?]