No Chest Pain, No Problem?

Acute coronary syndrome symptom of chest pain not reported by all patients

For people experiencing heart problems, a quick and accurate diagnosis, which usually relies on the presence of chest pain symptoms, is essential for receiving the necessary treatment. However, some people don't experience chest pain when they have heart health issues.

A recent study looked at a group of people experiencing various heart symptoms in order to find out which people didn't experience chest pain.

The researchers found that about one in five women under 55 years old did not report classic chest pain symptoms when they are experiencing heart issues. Most patients with heart problems who didn't have chest pain reported some other symptom, like shortness of breath, weakness or pain on the left side of the body.

The researchers concluded that doctors and patients should be aware of other symptoms of heart problems, because a lack of chest pain does not necessarily mean a lack of heart problems.

"Become familiar with the symptoms of heart problems."

Nadia Khan, MD, MSc, of the Department of Medicine in the Center for Health Evaluation and Outcomes Science at the University of British Columbia, and colleagues conducted this study to see if there were differences based on sex in acute coronary syndrome symptoms in young patients.

Acute coronary syndrome, or ACS, refers to a group of symptoms, physical exam findings, along with EKG and laboratory findings, that indicate acute strain and/or damage to heart muscle. One of the classic causes of ACS is blockage of an artery supplying oxygen to the heart muscle.

Chest pain is the main symptom of ACS, so patients without chest pain are often assumed to not have ACS. However, according to background information of this study, about 35 percent of patients with ACS do not report chest pain, or they report only minor chest pain. Previous studies have shown that women were more likely than men to not report experiencing chest pain as an ACS symptom.

This study looked specifically at younger populations, age 55 years or younger, to see if there was a sex difference in the types of symptoms reported by patients with ACS.

The researchers studied 1,015 patients who had been hospitalized with ACS and had enrolled in a cardiovascular study, GENESIS PRAXY, from January 2009 to September 2012. Of these participants, 30 percent were women. 

The participants had an average age of 49 years, and 40 percent were obese.

Participants did not have to have chest pain to be diagnosed with ACS.

The researchers collected data on the symptoms that the patients had using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey, or MAPMISS. MAPMISS assesses 37 symptoms and their intensity to make a diagnosis.

They found that chest pain was the most common symptom reported for both women and men. The partcipants also reported other common symptoms of ACS like weakness, shortness of breath and left arm pain.

While only 13.7 percent of men presented without chest pain symptoms, 19 percent of women did not report feeling chest pain. Women without chest pain also reported an average of two fewer symptoms than women with chest pain.

Overall, cold sweats and weakness were symptoms of ACS that were most strongly associated with more serious heart attacks than other symptoms. The lack of chest pain was not associated with less serious ACS diagnoses.

For people who had ACS but did not have chest pain symptoms, there was no discernible pattern of symptoms that they shared.

"Although all participants in the study by Khan et al were admitted for ACS, their results shed light on the potential for physicians to miss a case of ACS when the cardinal symptom of chest pain is not experienced or elicited," wrote Akintunde Akinkuolie, MBBS, MPH, and Samia Mora, MD, MHS, in an editorial accompanying the research.

This study was published in JAMA Internal Medicine on September 16.

The study was funded by the Canadian Institutes of Health Research and the Heart and Stroke Foundations of Quebec, Nova Scotia, Alberta, Ontario, Yukon and British Columnbia. The authors disclosed no conflicts of interest.

Review Date: 
September 13, 2013