AHA statement outlines symptoms of common heart conditions

Symptoms of six common cardiovascular diseases (CVDs) — acute coronary syndromesheart failure, valve disorders, stroke, arrhythmias and peripheral vascular disease – often overlap and can vary over time and by sex, notes the American Heart Association (AHA) in a new scientific statement.

“Symptoms of these cardiovascular diseases (CVDs) can profoundly affect quality of life, and a clear understanding of these is essential for effective diagnosis and treatment decisions,” said Corrine Y. Jurgens, PhD, President of the editorial board, in a press release. .

This scientific statement is a “compendium detailing symptoms associated with cardiovascular disease, similarities or differences in symptoms between conditions, and gender differences in symptom presentation and reporting,” said Jurgens, associate professor at Connell School of Nursing, Boston College, Massachusetts.

“State of the Science: The Relevance of Symptoms in Cardiovascular Disease and Research” has been published online August 18 to Traffic.

The writing group notes that measuring CVD symptoms can be difficult due to their subjective nature. Symptoms may go unnoticed or go unreported if people think they are unimportant or related to an existing health problem.

“Some people may not see symptoms as fatigue, sleep disorder, weight gain and depression as important or related to cardiovascular disease. However, research indicates that subtle symptoms like these can predict acute events and the need for hospitalization,” Jurgens stressed.

ACS – Chest Pain and Associated Symptoms

The writing group notes that chest pain is the most commonly reported symptom of ACS and has often been described as substernal pressure or discomfort and may radiate to the jaw, shoulder, arm or upper back. .

The most common concomitant symptoms are dyspnoea, diaphoresis, unusual fatigue, nausea and dizziness. Women are more likely than men to report additional symptoms aside from chest pain.

As a result, they have often been referred to as “atypical”. However, a recent AHA Reviews notes that this label may have been due to the lack of women included in the clinical trials from which the symptom lists were derived.

The drafting group says there is a need to “harmonize” the measurement of ACS symptoms across research. The current lack of harmonization of ACS symptom measurement across research hampers the growth of cumulative evidence, they note.

“Therefore, little can be done to synthesize key findings about symptoms across ischemic heart disease/ACS and incorporate evidence-based symptom information into treatment guidelines and patient education materials,” they warn.

Heart failure

With respect to heart failure (HF), the writing group notes that dyspnea is the classic symptom and a common reason adults seek medical attention.

However, early and more subtle symptoms should be recognized. These include gastrointestinal symptoms such as upset stomach, nausea, vomiting, and loss of appetite; fatigue; exercise intolerance; insomnia; pain (chest and other); mood disorders (mainly depression and anxiety); and cognitive dysfunction (brain fog, memory problems).

Women with IC report a greater variety of symptoms, are more likely to suffer from depression and anxiety, and report a lower quality of life than men with IC.

“It is important to consider the heterogeneity of dyspnea in clinical practice and research using nuanced measures and probing questions to capture this common and multifaceted symptom,” states the writing group.

“Monitoring symptoms on a spectrum, relative to present or not, with reliable and valid measures can improve clinical care by more quickly identifying those who may be at risk for poor outcomes, such as lower quality of life, hospitalization or death,” Jurgens added.

“Ultimately, we have work to do to determine who needs more frequent monitoring or intervention to avoid poor HF outcomes,” she said.

Valvular heart disease

Valvular heart disease is a common cause of HF, with symptoms usually indistinguishable from other causes of HF. Rheumatic heart disease is still prevalent in low- and middle-income countries, but has largely disappeared in high-income countries, with aging populations and cardiomyopathy now the main drivers of heart valve disease.

In the absence of severe acute valve dysfunction, patients typically have a prolonged asymptomatic period, followed by a period of progressive symptoms, resulting from the valve injury itself or from secondary myocardial remodeling and dysfunction, indicates the drafting group.

Symptoms of aortic valve disease often differ between men and women. Aortic stenosis is usually silent for years. As the stenosis progresses, women report dyspnea and exercise intolerance more often than men. Women are also more likely to be physically frail and have a higher New York Heart Association class (III/IV) than men. Men are more likely to have chest pain.

“Given the importance of symptom assessment, further work is needed to determine the additional value of quantitative symptom measurement as an aid to clinical management,” states the writing group.

Stroke

For clinicians, classic stroke symptoms (droopy face, arm weakness, slurred speech), in addition to non-classic symptoms, such as partial sensory deficit, dysarthria, vertigo, and diplopia, should be considered account for activating a stroke response team, according to the group.

A systematic review and meta-analysis found that women with stroke were more likely to have non-focal symptoms (eg, headaches, altered mentality, and coma/stupor) than men, they note. .

To improve public education about stroke symptoms and to aid in the diagnosis and treatment of stroke, they say research is needed to better understand the presentation of stroke symptoms by other features. selected demographics, including race and ethnicity, age, and stroke subtype.

Post-stroke screening should include assessment for anxiety, depression, fatigue and pain, according to the writing group.

Arrhythmias

Regarding arrhythmias, the drafting group notes that cardiac arrhythmias, including atrial fibrillation (AF), atrial flutter, supraventricular tachycardiabradyarrhythmia and Ventricular tachycardiahas common symptoms.

Palpitations are a characteristic symptom of many cardiac arrhythmias. The most common cardiac arrhythmia, AF, can manifest as palpitations or less specific symptoms (fatigue, dyspnea, dizziness) that occur with a wide range of arrhythmias. Chest pain, dizziness, presyncope/syncope, and anxiety occur less frequently in AF, depending on the group.

Palpitations are considered the typical presentation of AF symptoms, but patients with new-onset AF often present with nonspecific symptoms or no symptoms, they point out.

Women and younger people with AF usually present with palpitations, while men are more often asymptomatic. Advanced age also increases the likelihood of a non-classic or asymptomatic presentation of AF.

Although non-Hispanic black people are less at risk of developing AF, research suggests that black patients are more burdened with palpitations, dyspnea on exertion, exercise intolerance, dizziness, dyspnea on rest and chest discomfort compared to white or Hispanic patients.

Peripheral vascular disease

Classic claudication occurs in approximately one-third of patients with peripheral arterial disease (PAD) and is defined as calf pain that occurs in one or both legs with exertion (walking), does not begin at rest, and resolves within 10 minutes of stopping or walking. Rest.

However, non-calf exercise pain is reported more frequently than classic claudication symptoms. Women with PAD are more likely to have non-classical symptoms or no symptoms.

Assessing symptoms at rest, during exercise and during recovery can help classify symptoms as ischemic or not, according to the writing group.

PAD with symptoms is associated with an increased risk of myocardial infarction and stroke, with men being more at risk than women.

Similar to PAD, peripheral venous disease (PVD) can be symptomatic or asymptomatic. The clinical classification of PVD includes symptoms such as leg pain, body aches, fatigue, heaviness, cramps, tightness, restless leg syndromeand skin irritation.

“Measurement of vascular symptoms includes assessment of quality of life and activity limitations, as well as the psychological impact of disease. However, existing measures are often based on clinician assessment rather than self-reported symptoms and symptom severity,” Jurgens commented. .

Watch out for depression

Finally, the writing group also highlights the importance of depression in heart patients, which occurs about twice as often as people without a medical condition (10% versus 5%).

In an earlier statement, the AHA said depression should be considered a risk factor for worse outcomes in patients diagnosed with ACS or CVD.

The new statement highlights that people with persistent chest pain, people with HF, as well as stroke survivors and people with PAD typically suffer from depression and/or anxiety. Additionally, cognitive changes after a stroke can affect how and if symptoms are felt or noticed.

While symptom relief is an important part of cardiovascular disease management, it’s also important to recognize that “factors such as depression and cognitive function can affect symptom detection and reporting,” Jurgens said.

“Symptom monitoring and measurement with tools that appropriately account for depression and cognitive function can help improve patient care by more quickly identifying people who may be at higher risk,” a- she added.

This scientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Cardiovascular and Stroke Nursing; the Hypertension Council; and the Stroke Council.

This research had no commercial funding. The authors did not report any relevant financial relationships.

Traffic. Published online August 18, 2022. Summary

Follow Medscape on Facebook, Twitter, instagramand Youtube.