ESC: Recognising myocardial infarction signs and symptoms improves survival

25th August 2023

Recognising the signs and symptoms of a myocardial infarction is linked with faster life-saving treatment and reduced in-hospital mortality, according to a recent study presented at the 2023 European Society of Cardiology (ESC) congress in Amsterdam.

Researchers in the Republic of Korea have found a correlation between symptom recognition, time to treatment and mortality in those experiencing a myocardial infarction.

Although AI-based tools are becoming potentially valuable as an aid to quickly diagnose a myocardial infarction, if patients are capable of recognising the most common symptoms, this too could ensure they receive prompt treatment.

The current study, ‘Effect of symptoms recognition in patients with recurrent acute myocardial infarction: from KRAMI-RCC stratification in acute coronary syndromes’, used data from KRAMI-RCC – a registry of myocardial infarction patients in the Republic of Korea.

Trained nurses consulted with survivors of myocardial infarction, asking them if they recognised six sets of symptoms: chest pain; shortness of breath; cold sweat; radiating pain to the jaw, shoulder or arm; dizziness, vertigo, lightheadedness, loss of consciousness; and stomach ache.

Patients were then classified as ‘recognised symptoms‘ if they could identify at least one symptom, otherwise they were classified as ‘did not recognise symptoms‘.

Recognising myocardial infarction and survival outcomes

The study included 11,894 myocardial infarction patients, of whom 90.4% had a first-time event and 9.6% a repeat event. Overall, just over half (52.3%) of patients recognised the symptoms. 

The majority of patients (92.9%) could identify chest pain as a symptom. However, only a third (32.1%) identified shortness of breath and cold sweats (31.4%) and just 1.3% recognised stomach ache.

Among 57.4% of patients who correctly identified the symptoms, treatment was received within two hours, compared to 47.2% of those who did not recognise the symptoms.

Moreover, the in-hospital mortality rate was much lower for those able to recognise symptoms (1.5% vs 6.7%).

For patients with recurrent myocardial infarction, the recognition rate was 57.5% for those previously enrolled in KRAMI-RCC and just 14.4% of patients with a first-time myocardial infarction could identify the symptoms.

Study author Dr Kyehwan Kim of Gyeongsang National University Hospital in Jinju, Republic of Korea, said: ‘The findings indicate that education is needed for the general public and heart attack survivors on the symptoms that should trigger calling an ambulance.

‘In our study, patients who knew the symptoms of a heart attack were more likely to receive treatment quickly and subsequently survive. Women, older patients, those with a low level of education and people living alone may particularly benefit from learning the symptoms to look out for.‘

Cardiovascular symptoms present in nearly half of cannabis intoxicated patients seen in ED

5th April 2023

Cardiovascular symptoms have been identified in nearly half of cannabis intoxicated patients who present at an emergency department

Among patients presenting at an emergency department (ED) with cannabis intoxication, almost half presented with cardiovascular (CV) symptoms according to the findings of a retrospective analysis by researchers from Amsterdam, the Netherlands.

In a study with 10,000 students, cannabis was rated as the most favourable most commonly used tobacco product the past 30 days and also perceived as the least harmful when compared to electronic cigarettes and cigarettes themselves. However, cannabis use is not without risks and one systematic review found that the data from 29 observational studies, suggested an association between cannabis-based product use and cardiovascular disease, with the strongest evidence for ischaemic heart disease. There is also data to suggest that cannabis use is associated with an increased risk of cardiac dysrhythmia, which is rare but may be life-threatening. As a result, there remains some uncertainty over whether patients who present at an ED with cannabis intoxication should undergo a full cardiovascular evaluation.

In the current study, the Dutch team retrospectively analysed data on a convenience sample of all self-reported cannabis-intoxicated adult patients who presented at an Amsterdam ED. Individuals who were intoxicated due to mixed recreational drug use were excluded and presenting symptoms were categorised as either CV-related (e.g., palpitations, chest pain and syncope) or non-cardiovascular (like nausea and vomiting). 

Cardiovascular symptoms and cannabis intoxication

A total of 1689 individuals with a mean age of 31.9 years (62.4% male) were included in the study.

Overall, 47.2% presented with cardiovascular symptoms and which included palpitations (57.6%), chest pain (12.9%) and syncope (36.8%). Among those with CV-related symptoms, 8 had complications including ST elevation myocardial infarction, non-ST elevation myocardial infarction, atrial fibrillation and AV-nodal re-entrant tachycardia. Other ECG abnormalities observed were ischaemic ECG changes, first-degree atrioventricular block, premature atrial complexes, ventricular extrasystoles, prolonged corrected QT interval, and a Brugada type 1 pattern. Fortunately, all of these resolved spontaneously during the observational period.

The authors concluded that while the clinical relevance of cardiovascular symptoms is largely unknown, cannabis-intoxicated patients should have a cardiac evaluation, and symptoms should not just be considered benign.

Citation
Gresnigt F et al. Incidence of cardiovascular symptoms and adverse events following self-reported acute cannabis intoxication at the emergency department: a retrospective study. Emerg Med J 2023