Feeling puffed? could be a sign of serious heart problem

Nov 3 2005

Most people know that chest pain can indicate the presence of heart disease, but less well known apparently is that shortness of breath can also be a symptom of serious cardiac problems.

In fact researchers at Cedars-Sinai Medical Center say they believe that patients with shortness of breath may have a higher risk of dying from cardiac disease than patients without symptoms; higher even than patients with typical cardiac pain.

The researchers report that shortness of breath was a significant predictor of death from cardiac causes, as well as death from any other cause.

Their study was based on a retrospective evaluation of medical records of nearly 18,000 patients referred for cardiac stress testing who were then followed-up later.

It was found that when compared to patients without shortness of breath, those with shortness of breath were significantly more likely to experience death from cardiac cause than patients without shortness of breath.

In a surprising revelation more than 1,000 of the patients denied having chest pain but answered "yes" to the question, "Do you experience shortness of breath?"

Daniel Berman, M.D., senior author of the study and the Director of Cardiac Imaging at Cedars-Sinai Medical Center, says that patients often do not interpret shortness of breath as a serious symptom.

However in patients who have cardiac risk factors and in patients without lung disease, it may be the only sign of the presence of serious coronary artery disease that may need treatment.

Berman says if patients with coronary disease are identified before an event occurs, then the vast majority of the cardiac events could be prevented by modern therapies.

The retrospective study found that patients without known coronary artery disease who had shortness of breath were four times more likely to suffer death from a cardiac cause than asymptomatic patients and twice as likely as patients with chest pain considered to be typical cardiac pain.

Berman says the findings may be explained in part by the fact that doctors are more likely to send patients with chest pain to bypass surgery or angioplasty than patients with shortness of breath.

Coronary artery disease is usually associated with the presence of plaque build-up in the arteries surrounding the heart and is one of the main causes of death in both men and women.

While it often is associated with chest pain, about half of the patients with this serious disease either die suddenly without prior symptoms or have a heart attack as the first manifestation of the disease.

Dr Berman says their findings are important for the public as well as for doctors,and may encourage doctors to refer patients with shortness of breath for testing, and then more readily send those who are found to be at serious risk for a life-saving revascularization procedure.

As for patients, increased awareness of unexplained shortness of breath as a possible cardiac symptom will hopefully prompt them to see their doctor sooner rather than later.

The study is published in the current issue of the New England Journal of Medicine.