Shortness of breath may be a sign of heart attack with lesser survival rate: Study

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Shortness of breath may be a sign of heart attack and lead to less survival than those with typical symptoms of chest pain, according to a study.

The researchers from Braga Hospital in Portugal, showed that just 76 per cent of heart attack patients with dyspnoea or fatigue as their main symptom are alive at one year compared to 94 per cent of those with chest pain as the predominant feature.

"Patients presenting with shortness of breath or fatigue had a worse prognosis than those with chest pain. They were less likely to be alive one year after their heart attack and also less likely to stay out of hospital for heart problems during that 12-month period," said Dr. Paulo Medeiros from the Hospital.

"Dyspnoea and extreme tiredness were more common heart attack symptoms in women, older people and patients with other conditions such as high blood pressure, diabetes, kidney disease and lung disease," Medeiros added.

Chest pain is the hallmark presentation of myocardial infarction but other complaints such as shortness of breath, upper abdominal or neck pain, or transient loss of consciousness (blackouts) may be the reason to attend the emergency department.

The study focused on non-ST-elevation myocardial infarction (NSTEMI), a type of heart attack in which an artery supplying blood to the heart becomes partially blocked.

The study included 4,726 patients aged 18 years and older admitted with NSTEMI between October 2010 and September 2019.

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 per cent), followed by dyspnoea/fatigue (332 patients; 7 per cent) and syncope (81 patients; 2 per cent). Syncope is a temporary loss of consciousness caused by a fall in blood pressure.

Patients with dyspnoea/fatigue were significantly older than those in the other two groups, with an average age of 75 years compared with 68 years in the chest pain group and 74 years in the syncope group.

Those with dyspnoea/fatigue were also more commonly women (42 per cent) compared to patients with chest pain as the main symptom (29 per cent women) or syncope (37 per cent women).

Compared to the other two groups, patients with dyspnoea/fatigue as their main symptom were more likely to also have high blood pressure, diabetes, chronic kidney disease and chronic obstructive pulmonary disease (COPD).

"This study highlights the need to consider a diagnosis of myocardial infarction even when the primary complaint is not chest pain. 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," Medeiros said.

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