No Chest Pain In One
Third Of US Heart Attacks
By Michael Conlon
CHICAGO (Reuters) - A study of hundreds of thousands of U.S. heart attack victims has found that as many as a third suffered no chest pain and that these people were less likely to seek help and twice as likely to die, researchers said on Tuesday.
The findings are ``quite surprising,'' said John Canto, director of the Chest Pain Center at the University of Alabama in Birmingham who headed the study. He said the public and doctors need to be warned that chest pain is not necessarily the ``golden rule'' by which heart attacks are identified.
Medical experts said other heart attack symptoms are pain or discomfort in the back, jaw, neck, shoulder, arm or stomach, shortness of breath, sweating, irregular heart rhythms, fainting spells, general weakness and sudden indigestion.
Canto's study, published in this week's Journal of the American Medical Association, found that people who had previously suffered heart failure or a stroke were less likely to have chest pain with their heart attacks. Older patients and women were also at a higher risk of a heart attack without the signature chest pain.
In an interview, Canto said the lack of chest pain among diabetics may be explained by the fact that the disease can cause a decline in pain sensation, particularly in the extremities and perhaps in the chest.
But, asked to explain the lack of chest pain in other patients, he said. ``We don't know why. ... It's just the way it is.''
A heart attack happens when blood supply is cut off to an area of heart muscle, causing tissue death. The pain comes from nerves responding to the oxygen deprivation.
The Alabama researchers analyzed records from a national data bank covering 434,877 patients with confirmed myocardial infarctions.
``Of all patients diagnosed ... 142,445 (33 percent) did not have chest pain on presentation to the hospital,'' the study said.
That group had a longer delay before arriving at a hospital -- about two hours longer -- and was less likely to have been diagnosed with a heart attack or receive such treatments as thrombolysis, angioplasty, aspirin, beta-blockers or heparin.
``Myocardial infarction patients without chest pain had a 23.3 percent in-hospital mortality rate compared with 9.3 percent among patients with chest pain,'' the study found.
``Identifying the signs and symptoms of acute myocardial infarction is paramount to successful management and early treatment,'' Canto said. ``Patients must first believe that their symptoms are consistent with a heart attack, and already numerous reports have shown that patients may procrastinate if they do not know their symptoms may indicate a heart attack.''

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