Key result
ACS without chest pain commonly features dyspnea and is linked to delayed care and higher mortality.
Why the study?
Early symptom recognition in acute coronary syndrome is critical but challenging when patients present without chest pain.
Patients with ACS presenting without typical chest pain often present with dyspnea, are older, and suffer worse outcomes due to delayed diagnosis and suboptimal care, underscoring the need for better symptom recognition.
Clinicians should suspect ACS in dyspnoeic patients without chest pain to reduce delays; reinforces higher mortality in systematic review data.
For patients experiencing acute coronary syndrome, early symptom recognition is paramount; this is challenging without chest pain presentation. The aims of this scoping review were to collate definitions, proportions, symptoms, risk factors and outcomes for presentations without cardiac chest pain. Full-text peer reviewed articles covering acute coronary syndrome symptoms without cardiac chest pain were included. MEDLINE, CINAHL, Scopus and Embase were systematically searched from 2000 to April 2023 with adult and English limiters; 41 articles were selected from 2,954. Dyspnoea was the most reported (n=39) and most prevalent symptom (11.6-72%). Neurological symptoms, fatigue/weakness, nausea/ vomiting, atypical chest pain and diaphoresis were also common. Advancing age appeared independently associated with presentations without cardiac chest pain; however, findings were mixed regarding other risk factors (sex and diabetes). Patients without cardiac chest pain had worse outcomes: increased mortality, morbidity, greater prehospital and intervention delays and suboptimal use of guideline driven care. There is a need for structured data collection, analysis and interpretation.
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Perona et al. (2024) conducted a review in Acute Coronary Syndrome. Presentation without cardiac chest pain vs. Presentation with cardiac chest pain was evaluated on Prevalence of atypical symptoms and clinical outcomes. Acute coronary syndrome presentations without cardiac chest pain most commonly featured dyspnoea (11.6-72%) and were consistently associated with worse outcomes, including higher mortality and delayed care.
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