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Just 6 Percent of Chest Pain Cases in ER Are Life-Threatening: Study

Muscle strains, anxiety, gastrointestinal issues often to blame, doctor says

By Randy Dotinga
HealthDay Reporter

WEDNESDAY, June 15, 2016 (HealthDay News) -- Americans who develop chest pain often rush to the hospital, where they're treated with urgency. A new study suggests, however, that less than 6 percent of these patients suffer from life-threatening conditions such as a heart attack.

Most often, physicians can't determine the cause of patients' chest pain, the researchers found.

But chest pain can be a sign of serious illness, cautioned study lead author Dr. Renee Hsia, an emergency room physician and director of Health Policy Studies at the University of California, San Francisco.

"This doesn't mean that patients shouldn't be worried when they experience chest pain," she said. "Depending on their risk factors, they certainly could be having a heart attack or another life-threatening condition, which is why it is important to seek timely medical care.

"In the right patient population with risk factors, we should certainly proceed with appropriate testing to exclude the possibility of life-threatening conditions," she added.

In the United States, chest pain accounts for more than 8 million emergency room visits a year. Only abdominal pain brings in more patients, Hsia said.

"Chest pain is very worrisome because it can be a harbinger of serious illness, such as a heart attack or aortic dissection [tear in the aorta], for example," she said. As a result, patients with chest pain often get treated before others because their condition is considered more urgent, she said.

For the new study, researchers analyzed a database that includes details from a sampling of U.S. emergency room visits. They focused on nearly 11,000 patient records from 2005 to 2011 for chest pain not due to trauma, such as a car accident.

Only 5.5 percent of patients were diagnosed with six conditions thought to be life-threatening: blocked blood vessels due to heart attack or a similar condition; tear in the aorta; lung embolisms; lung collapses; esophageal ruptures; and perforated peptic ulcers.

Heart attack-type events accounted for nearly all of those life-threatening diagnoses. The likelihood of the other conditions is rare, the researchers found.

Overall, 57 percent of the patients were discharged. Fifty-one patients (0.4 percent) died in the hospital or emergency room.

According to the study, the most common diagnosis for chest pain is "nonspecific chest pain," which means a cause couldn't be determined. This occurred in more than five out of 10 patients examined for chest pain.

In those "non-specific" cases, what's going on?

Muscle strains, anxiety and gastrointestinal issues may explain many of the symptoms, said Dr. Michael Weinstock. He is chairman of the emergency department and director of medical education at Mount Carmel St. Ann's Hospital, in Westerville, Ohio.

Weinstock's own research has reached similar conclusions. Still, "everybody knows somebody who dropped dead of a massive heart attack," he said, and chest pain can be a sign. "That's what scares patients and doctors so much. Nobody wants to send someone home who may be having a heart attack."

Weinstock said patients who experience chest pain shouldn't do anything differently as a result of this new study: They should call their primary doctor or 911.

Chest pain is especially urgent for women, the elderly and diabetics, he said, and when it comes with symptoms such as dizziness, passing out or shortness of breath.

The study was published June 13 in JAMA Internal Medicine.

More information

For more about chest pain, visit the American Heart Association.

SOURCES: Renee Hsia, M.D., MSc, professor and director, Health Policy Studies, Department of Emergency Medicine, University of California, San Francisco, and attending physician, San Francisco General Hospital and Trauma Center; Michael Weinstock, M.D., chairman, Emergency Department, and director, medical education, Mount Carmel St. Ann's Hospital, Westerville, Ohio. June 13, 2016, JAMA Internal Medicine

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