Heart attack patients with shortness of breath or fatigue may have worse prognosis than those with chest pain

Heart attack patients with chest pain as the predominant feature may be more likely to survive than patients with dyspnoea or fatigue as their main symptom, according to research presented at ESC Acute CardioVascular Care 2022.

The study’s results showed that just over three quarters (76%) of heart attack patients with dyspnoea or fatigue as their main symptom are alive at one year compared to 94% of those with chest pain as the predominant feature.

Study author Dr. Paulo Medeiros of Braga Hospital, Portugal said that while the study “did not show these symptoms cause poorer outcome, they are warning signs of greater risk.”

Patients with dyspnoea/fatigue were older, more commonly women and more likely to have other health conditions

The researchers use data from 4,726 patients aged 18 years and older from the Portuguese Registry of Acute Coronary Syndromes; the average age of the participants was 68 years and 71% were men.

Patients were divided into three groups according to their main symptom at presentation. Chest pain was the most common presenting symptom (4,313 patients; 91%), followed by dyspnoea/fatigue (332 patients; 7%) and syncope (81 patients; 2%).

Patients with dyspnoea/fatigue were significantly older than those in the other two groups, were more commonly women, and were more likely to have high blood pressure, diabetes, chronic kidney disease and chronic obstructive pulmonary disease compared to the other groups.

As well as patients in the chest pain and syncope group being more likely to survive than those in the dyspnoea/fatigue group, they were also less likely be hospitalised following a cardiovascular event – 76% of patients in the dyspnoea/fatigue group avoided being hospitalised for a cardiovascular reason, compared to 85% of the chest pain group and 83% of the syncope group.

None of the symptoms emerged as independent predictors

Dr. Medeiros said: “Shortness of breath was more common among patients that died during the year after their heart attack. 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.”

“This study highlights the need to consider a diagnosis of myocardial infarction even when the primary complaint is not chest pain. 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,” he concluded.