The heart attack is deceiving, in one out of four cases it doesn’t give the classic pain

Pain behind the breastbone, which radiates upward, in the shoulders and arms, especially in the left arm. When a heart attack is defined, these are the signals that classically must call for help immediately to reach the emergency room as soon as possible. Arriving early means in fact being able to carry out all the necessary maneuvers to restore blood to the heart muscle area affected by ischemia, starting from angioplasty with stent placement, and therefore limit the damage of the lesion. Too bad, however, that this textbook path is not always possible. Infarction, in fact, can sometimes “deceive”, presenting with disorders that do not properly suggest a heart attack. The breathing becomes labored, the pain affects the upper abdomen suggesting a stomach ache, one suddenly feels tired to the point that it becomes difficult to take a few steps.

This is not a rare occurrence, given that in almost 25 percent of cases this is how the heart injury is presented. This “difference” is found above all in women and elderly people. This percentage is confirmed by a research published in European Heart Journal – Acute Cardiovascular Care, which also signals another worrying reality: those who face these “masked” heart attacks obviously tend to respond late to the emergency and above all, at a distance, they can have worse outcomes, with a greater risk of mortality after 30 days than those he had a heart attack with a classic presentation. According to the author of the research Amalie Lykkemark Møller, from Nordsjællands Hospital, Hillerød, Denmark, the atypical symptoms would be “more common among older people, especially women, who have called a non-emergency helpline. This suggests that patients were unaware that their symptoms required urgent attention. ”

The study looked at associations between initial heart attack symptoms, health service response, and 30-day mortality. Analyzing calls to a 24-hour medical helpline and an emergency number in the capital region of Denmark for five years, between 2014 and 2018. In the two services, the main symptom is recorded along with the response. All subjects who had a diagnosis of heart attack within the three days following the call were then considered in the analysis, divided into groups based on the main symptoms reported. The impact of the “deceptive” heart attack was thus drawn. The analysis shows that a specific primary symptom was recorded for 7,222 of the 8,336 heart attacks. In 72 percent of cases there was classic chest pain, but in 24 percent of patients the most common symptoms were respiratory or otherwise different. The prevalence of chest pain was highest among men aged 30 to 59 who called the emergency number and lowest among women over 79 who called the medical help number. The atypical symptoms were found mainly among older patients, particularly women, who called the helpline. Among patients with cardiac ischaemia and chest pain, 95 percent and 76 percent received an emergency message from the emergency number and medical helpline, respectively. But when cardiac ischemia presented atypically only 62 percent and 17 percent of patients with “deceptive” heart attacks received an emergency message from the emergency number and medical assistance service, respectively.

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Finally, this situation has had repercussions on diagnoses and treatments. The 30-day death rate for heart attack patients with chest pain was 5 percent among those who called the helpline and 3 percent among those who called the emergency number. The percentages were much higher among those who had a heart attack with atypical symptoms. After reviewing the information, including social and health parameters such as diabetes, previous heart attack, heart failure and chronic respiratory disease, one-month mortality was 4.3 percent for patients with chest pain and 15.6 percent for those with atypical symptoms. In short: even if often “general” symptoms do not make us think of the heart, this hypothesis should not be ruled out a priori, especially in the elderly. The time factor in the management of cardiac ischaemia is crucial.