|
 But doctors should take it as a possible warning sign because even
when the pain is not readily explainable by heart-related or other
causes, these people have a higher risk of heart attacks and other
cardiac problems over the next five years, researchers say.
“Most people who consulted their GP with chest pain, the cause was
not clear, and rather surprisingly the study team found most of
these people still did not have a diagnosis for their chest pain six
months later,” Dr. Peter Croft, one of the study authors, told
Reuters Health by email.
“We followed this group up for 5 years and found they had a small
but definite extra risk of heart disease compared with the group who
had been given a definite diagnosis unrelated to heart disease (5
people per 100 in the ‘cause not clear’ group developed a
heart-related problem over 5 years compared to 3 per 100 in the
‘cause unrelated to heart’ group),” said Croft of the Research
Institute for Primary Care and Health Sciences at Keele University
in Staffordshire.
Croft said patients should feel reassured, though, because the study
also found that when people consulted their GPs about chest pain,
the doctors were generally good at assessing who was most and least
likely to have heart disease.
“If the GP decided the chest pain was not caused by heart disease
but by other conditions like stomach problems or muscle strains or
chest infection, then this group of patients had the lowest risk of
future heart problems (measured over five years),” Croft said.
If the GP decided the chest pain was probably caused by heart
disease or decided to send the patient for cardiac investigations
anyway, then this group turned out to have the highest rate of
future heart diagnoses, he added.
The study analyzed data from UK electronic health record databases
for more than 170,000 adults with no history of heart disease who
saw their doctors for chest pain for the first time between 2002 and
2009. The patients ranged from 18 years old to over 75, with half
under age 49.
For 72 percent of patients, no cause for the chest pain was recorded
by the doctor, the study team reports in The BMJ. Another 23 percent
had a diagnosis of chest pain caused by issues not related to the
heart, and about 5 percent had chest pain that was heart-related,
known as angina.
Less than 12 percent of the patients with chest pain that didn’t
have an established cause underwent further diagnostic testing for
heart problems.
[to top of second column] |
After a follow-up period of up to 5.5 years, the patients with
unexplained chest pain were 36 percent more likely to have a heart
attack compared to those whose pain got a diagnosis that wasn’t
related to the heart.
Croft said he believes people whose chest pain remains undiagnosed
could benefit from advice to reduce their cardiovascular risk.
“Even though an individual patient in this group is much less likely
to have heart disease than a patient who right from the start gets a
diagnosis of probable angina or a referral for cardiac
investigations from their GP, the majority of people with chest pain
who get a cardiovascular diagnosis in the next 5 years actually come
from this ‘cause not clear’ group,” he said.
Chest pain is a potentially serious symptom so a person should
always seek an explanation, said Dr. Tim Holt, a researcher with the
Medical Sciences Division of the University of Oxford who wrote an
editorial accompanying the study.
“As the BMJ study has shown, we are probably missing cases by
relying too heavily on symptom patterns, and there is a case for
doing more investigations if needed to either confirm heart disease
or to find a clearer alternative explanation,” he told Reuters
Health by email.
“If it is of sudden onset, severe, or associated with other symptoms
such as breathlessness, dizziness, palpitations or nausea, this is
an emergency, and it should be reported without delay,’ he said.
Holt said pain that could be described as "'tight,' 'heavy,'
'crushing,' 'like someone squeezing or sitting on the chest'" is of
particular concern. “This type of pain is more likely to be due to
heart disease.”
SOURCE: http://bit.ly/2pdLLtc and http://bit.ly/2oafTom The BMJ,
online April 3, 2017.
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
-Lincoln-IL/2831225863)
