When does chest pain signal a heart attack? New research indicates patients with longer-lasting chest pain are more likely to be suffering a heart attack than those with shorter bursts of pain.
The study, by researchers at Henry Ford Hospital in Detroit and published in the journal Critical Pathways in Cardiology, found ER patients evaluated for possible heart attack who reported chest pain lasting less than five minutes were not likely to be in danger. But those with pain lasting more than an hour were far more likely to be in the throes of cardiac arrest.
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The study is based on the medical charts of 426 patients — 38 of whom had a final diagnosis of heart attack, with average chest pain duration of 120 minutes, compared with 40 minutes in patients without heart attack. In patients with chest pain lasting less than five minutes, there were no heart attacks and no deaths at 30 days.
"These findings suggest that patients with chest pain lasting less than five minutes may be evaluated as an out-patient in their doctor's office; while patients with chest pain greater than 5 minutes, without a clear cause, should seek prompt medical evaluation in an emergency department," said James McCord, M.D., a cardiologist at Henry Ford Hospital on the research team.
Every year, up to 10 million people in the U.S. go to emergency departments for chest pain, but only 15 percent are having a heart attack.
"Patients can experience varying strength, location, and duration of chest pain," noted McCord. "The variety of symptoms any one patient may experience during a heart attack is a challenge to the physician who is trying to distinguish between patients who are having a heart attack and those who are not.
"Although an electrocardiogram and cardiac markers in the blood are important in the evaluation of patients with a possible heart attack, they are not 100 percent accurate."
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