Heart patients confused about chest pain symptoms

MedWire News: Many people who are at high risk of suffering a heart attack can not distinguish between life-threatening symptoms and less serious chest pain (angina), experts have warned.

Because of this confusion, many heart patients delay seeking emergency medical care when they start to develop symptoms, write Dr A Khavandi, from Southmead Hospital in Bristol, UK, and team in the British Medical Journal.

The researchers explain that recent survey results have shown that 40% of the general population would not immediately call an ambulance during a suspected heart attack, with the greatest delays among “high risk” people with heart disease.

Angina is one of the symptoms of a heart attack. But angina can also be a stable condition among heart disease patients that lasts just a few minutes and can be controlled with medications called nitrate sprays.

The team says that heart disease patients with angina are often given varying advice from doctors, health organisations and drug manufacturers about how to use nitrate sprays, and when to call an ambulance.

For example, the American College of Cardiology advises heart disease patients to use their spray just once, and to call an ambulance if the chest pain has not subsided after 5 minutes.

On the other hand, the British Heart Foundation advises patients with heart disease to use their nitrate sprays three times over a 15-minute period, and to call an ambulance if the chest pain does not subside during this time.

The researchers say that delaying emergency care by 15 minutes could be too long for some patients, as the length of time from the start of symptoms to a full blown heart attack can be as little as 10 minutes in some cases.

Dr Khavandi and team conclude: “We advise patients with known… heart disease or at high risk of myocardial infarction [heart attack] to carry a nitrate spray at all times and, should they develop acute chest pain, to take two metered doses (800 μg) immediately. If the pain persists at 5 minutes they should call an ambulance.

“They should not waste time by first calling a friend or relative and should not drive themselves to the emergency department. Patients and their relatives should also be taught how to recognise high risk features of chest pain, such as increasing frequency and severity of attacks.”

The British Heart Foundation said: “We acknowledge that advice can be confusing for people who know they have heart disease. Heart patients are prone to getting chest pain frequently – angina – and need clear guidance on how to distinguish angina pain from the symptoms of a heart attack.

“This is crucial as we know that heart disease patients tend to delay a long time before calling for an ambulance when they have a heart attack.

“BHF’s specific advice to heart patients – in our booklet ‘Angina’ – is given as a guide only and is intended to be used alongside one to one advice from a doctor about recognising their particular symptoms. Conversely, our Doubt Kills campaign has a broad message because it is aimed at the general public.

“But the main message for everyone remains clear: whether you have heart disease or not, if you think you are having a heart attack, call 999 immediately.”