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May 15, 2018

A Closer Look at Unexplained Chest Pain

Study sheds light on the needs of those who experience chest pain but don’t have heart disease.

There’s no clear answer about the potential health risks associated with unexplained chest pain, based on a recent study that explored the prognosis associated with chest pain in patients without heart disease.  

Published in the European Society of Cardiology, this analysis included 54 past studies that tracked outcomes in patients with chest pain and no heart disease. The purpose was to determine whether unexplained chest pain is relatively harmless or should serve as a warning sign of future heart risks.

Together, the analysis included 35,039 patients who were followed for a median of five years. Participants were 56 years old on average and had chest pain but no coronary artery disease.

Overall, researchers found no clear association between unexplained chest pain and future risk of heart attack and death. However, poorer outcomes were significantly associated with existing risk factors like high blood pressure, high cholesterol and diabetes. Authors also note that patients with some plaque build-up in the arteries had significantly higher risk of heart attack and death compared to those with clear arteries.

According to authors, that means that having early signs of heart disease (even minor plaque build-up) is associated with worse outcomes. Therefore, patients with signs of heart disease should work to address any existing cardiovascular risk factors like being overweight and having high blood pressure. Addressing these risk factors early has been shown to improve outcomes and reduce cardiovascular risk.

Findings also highlight the importance of improving quality of life among patients with unexplained chest pain. While unexplained chest pain had no clear impact on clinical outcomes in this study, many patients had recurrent chest pain. This chest pain frequently led to repeated hospitalizations and heart tests, which can take a toll on quality of life. Therefore, improving quality of life should be a treatment goal for patients with explained chest pain.

Most times, chest pain occurs when the heart’s arteries are narrowed or hardened due to heart disease. However, it’s estimated that 20–30% of patients with chest pain have no significant blockages. Many of these patients with chest pain are discharged from the hospital without a clear diagnosis or treatment plan.

Authors hope findings help shed light on this issue and encourage future research about chest pain in patients without obstructive heart disease.

Questions for You to Consider

  • What is angina?
  • Angina is chest pain brought on by a lack of oxygen supply to the heart. Angina can be recurring (chronic or stable angina) or can occur suddenly (unstable angina). It’s important to seek medical attention immediately if you experience unexplained chest pain, as it could be a sign of a heart attack.
  • How is angina treated?

  • Angina can be treated in a variety of ways, including lifestyle changes, medications, and medical procedures. For example, quitting smoking, losing weight and reducing stress can help successfully treat angina in some patients. For others, medications like beta blockers or procedures such as angioplasty and stenting may be necessary to treat the condition.

Featured Video

Dr. Anne R. Albers, FACC, presents at a Living with Chronic Angina event in Columbus, Ohio in Oct. 2014.

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This series of live educational programs provides educational and peer-support resources on chronic angina for patients and caregivers.

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To learn more about CardioSmart's Living with Chronic Angina educational sessions for patients, watch this video from a previous event.

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