Shortness of breath could signal heart attack with worst survival rate

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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Here's how leaky calcium puts epileptics at heart risk

Sudden unexpected death in epilepsy (SUDEP) has long bedeviled doctors and now, a team of researchers may have found the cause of it.

In a paper, researchers from Baylor College of Medicine reported how a mutation in a gene involved in the regulation of calcium inside brain cells can help trigger blackouts of the brain stem, the center that controls heartbeat and breathing, and increase the risk of sudden unexpected death.

"SUDEP turns out to be the most common cause of premature death in people with epilepsy. It's not accidents or suicide, it's just this unexplained mortality," said senior author Dr Jeffrey L. Noebels.

He added, "Most people with epilepsy live long lives and do not seem to have an increased risk of SUDEP. But there is a subset of people at additional risk. We have been looking for genes that cause epilepsy to see if any of them might give us a clue as to who might be at risk. Specifically, we have been looking at genes that might explain what appears to be a collapse of the cardiac and respiratory system after a seizure."

In their years-long quest to understand the cellular and genetic mechanisms that may trigger SUDEP, Noebels and his colleagues studied the genes that are involved in the heart beat. Some of these genes are already well known to be related to sudden unexpected cardiac death.

"We wondered whether some of those same genes could also cause seizures if they were expressed in the brain, and, if so, whether those genes would also place people with epilepsy at risk, not only for having epilepsy, but an abnormal heart beat and risk of death," said Noebels. "In our first experiments we found several genes that actually filled that description: they are expressed in the brain and the heart, and mutations of those genes cause an abnormal heart beat and epilepsy in mouse models."

The researchers then found that these same genes carry an additional risk for a phenomenon called spreading depolarization, a slowly-progressing, temporary electrical blackout of a region in the brain. During a blackout, the brain cells in that area cease their activity until it is restored.

Noebels and colleagues studied another gene - RyR2 - which is also expressed in the heart and known to cause heart problems. They showed that RyR2, which is also expressed in the brain, also causes epilepsy in mice and sets up an electrical surge that makes a fatal blackout likely.

For Noebels and colleagues, the discovery of how the 'leaky' RyR2 increases the chances of SUDEP is a step forward toward a future in which neurologists could sit with a patient and their family and have a conversation about the possibility of offering an accurate prediction of the risks of SUDEP and effective interventions.

The study is published on the Proceedings of the National Academy of Sciences. 

 

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