The most common symptom (72 percent) was chest pain, but 24 percent of patients who died within 30 days reported atypical symptoms normally not caused by a heart attack.

A study published in European Heart Journal – Acute Cardiovascular Care, says that when compared to patients with chest pain, patients with unusual symptoms were less likely to receive emergency help and were more likely to die within 30 days.

The study found that every fourth heart attack patient had unusual symptoms such as breathing difficulties, extreme exhaustion, and abdominal pain.

“We found that atypical symptoms were most common among older people, especially women, who called a non-emergency helpline for assistance,” said Ms. Amalie Lykkemark Møller, study author. “This suggests that patients were unaware that their symptoms required urgent attention.”

Heart attacks need to be treated quickly to keep people alive. Patients and health care workers need to be able to tell when they have a problem. This will help cut down on the time it takes to get help.

The study author added: “Little is known about how symptoms influence the actions of patients and medical services and impact survival.”

The researchers looked at the links between the first signs of a heart attack, the response of the medical community, and 30-day mortality. From 2014 to 2018, the researchers gathered data on all calls to a 24-hour medical hotline and an emergency number in Denmark’s Capital Region. The primary symptom, as well as the reaction, were recorded at both services. The researchers looked for persons aged 30 and up who were diagnosed with a heart attack within 72 hours after receiving the call. Patients were placed into groups based on the predominant symptom they were experiencing.

For 7,222 of 8,336 heart attacks, the most common symptom was chest pain (72 percent), whereas 24 percent of patients reported atypical symptoms, the most common of which was breathing problems. Men between the ages of 30 and 59 who called the emergency number had the most chest pain, while ladies over the age of 79 had the least. Atypical symptoms were mostly detected in older patients who called the helpline, especially women.

95 percent and 76 percent, respectively, of heart attack patients experiencing chest pain received an emergency dispatch from the emergency number or medical hotline. In comparison, just 62 percent of heart attack patients with unusual symptoms received an emergency dispatch from the emergency number and 17 percent from the medical hotline, respectively.

The 30-day death rate for heart attack patients with chest discomfort was 5% for those who dialed 911 and 3% for those who dialed a helpline. Patients with heart attacks who presented with unusual symptoms had a greater mortality rate: 23 percent died within 30 days before dialing the emergency number, compared to 15 percent who died after phoning the helpline.

To establish a more comparable assessment of mortality between patients with chest pain and those with atypical symptoms, the researchers controlled for age, gender, education level, diabetes, previous heart attack, heart failure, and chronic obstructive pulmonary disease. The standard 30-day mortality rate for people who had chest pain was 4.3 percent, and for people who had other symptoms, it was 15.6 percent.

The authors added: “Taken together, our results show that heart attack patients with chest pain were three times more likely to receive an emergency ambulance than those with other symptoms. People with atypical symptoms more often called the helpline, which could indicate that their symptoms were milder, or they were not aware of the severity. Vague symptoms may contribute to health staff misinterpreting them as benign.”

After chest pain, breathing difficulties, exhaustion, impaired consciousness, and stomach discomfort were the most prevalent heart attack symptoms, Ms. Mller emphasized that in most cases these problems are not caused by a heart attack.

“Unfortunately, people in this situation will not know the cause, but we hope our study improves awareness – particularly among older patients and health professionals – that it could be a heart attack,” she said.

“Death within 30 days was more than three-fold higher in those with atypical symptoms compared to chest pain,” she added.

“This could be due to treatment delays caused by not receiving the appropriate emergency dispatch. However, it is unknown whether an increase in emergency dispatches alone would improve survival among heart attack patients with atypical symptoms – we aim to investigate this in future research projects.”

Source: https://doi.org/10.1093/ehjacc/zuab023

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