The American Heart Association ’s new scientific statement indicates that symptoms often overlap between conditions and can vary by sex.
Highlights of the statement:
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Summary
Symptoms of cardiovascular disease drive health care use and contribute significantly to quality of life. Symptoms are of fundamental importance not only for the diagnosis of cardiovascular disease and the evaluation of the response to medical treatment, but also directly for the daily life of patients. The primary objective of this scientific statement is to present the state of the science and the relevance of symptoms associated with cardiovascular disease. Symptoms as patient-reported outcomes are reviewed in terms of genesis, manifestation, and similarities or differences between diagnoses. Specifically, symptoms associated with acute coronary syndrome, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease are reviewed. Secondary objectives include (1) describe symptom measurement methods in research and application in clinical practice and (2) describe the importance of cardiovascular disease symptoms in terms of clinical events and other patient-reported outcomes, as appropriate.
Comments
A review of the latest research highlights the most reported symptoms of several cardiovascular diseases (CVDs), noting that men and women often experience different symptoms .
The statement also highlights how symptoms are experienced over time, which can be months or years apart depending on the condition, and on a spectrum of severity or intensity, and notes the long-term nature of the development of cardiovascular disease. The scientific statements writing committee reviewed current research on the symptoms of different cardiovascular diseases. They found that symptoms vary over time and by sex.
Cardiovascular disease is the leading cause of death in the US and around the world. It includes several conditions, including the 6 reviewed in this scientific statement: heart attack, heart failure, valve disease, stroke, heart rhythm disorders, and disease of the peripheral arteries and veins.
“The symptoms of these cardiovascular diseases can profoundly affect quality of life, and a clear understanding of them is essential for effective diagnosis and treatment decisions. “The scientific statement is a compendium of the ‘state of the science’ detailing symptoms associated with cardiovascular diseases, similarities or differences in symptoms between conditions, and sex differences in presentation and reporting of symptoms,” he said. the chair of the scientific statements writing committee, Corrine Y. Jurgens. , Ph.D., RN, ANP, FAHA, associate professor at the Connell School of Nursing at Boston College.
Measuring symptoms: what is important?
Due to its subjectivity, measuring symptoms is difficult. Symptoms may go unnoticed or unreported if people do not believe they are important or related to an existing health condition. Furthermore, symptoms can occur without changes in disease progression and the disease state can also progress without symptoms.
"Some people may not consider symptoms such as fatigue, sleep disorders, weight gain and depression as important or related to cardiovascular disease," Jurgens said. “However, research indicates that subtle symptoms like these can predict acute events and the need for hospitalization. A broader definition of what constitutes a "major" symptom is warranted.
Some symptoms are common and well recognized in many types of cardiovascular diseases, while other symptoms are uncommon. For example, chest pain is the most common and recognizable symptom of a heart attack. Less familiar symptoms, however, include shortness of breath, fatigue, sweating, nausea, and dizziness . "Establishing a baseline symptom profile for an individual and tracking symptoms over time can be helpful in detecting changes and any progression of symptoms," Jurgens said.
Acute coronary syndrome
Heart attack is one of several conditions that fall under the broad category of acute coronary syndrome (ACS), a term that refers to any heart condition caused by a sudden loss of blood flow to the heart. The most common symptom of ACS, particularly heart attack, is chest pain , which is often described as pressure or discomfort, and may radiate to the jaw, shoulder, arm, or upper back. The most common concurrent symptoms are shortness of breath, sweating or cold sweat, unusual fatigue, nausea, and dizziness. These additional symptoms have often been called "atypical ," however, a recent presidential advisory from the American Heart Association explains that this label may be due to the lack of women included in the clinical trials from which the symptom lists were derived. Women are more likely than men to report more symptoms besides chest pain.
Heart failure
Shortness of breath is a classic symptom of heart failure and a common reason adults with heart failure seek medical care. However, early and more subtle symptoms should be recognized as signs to consult a health professional. These symptoms may include gastrointestinal symptoms such as upset stomach, nausea, vomiting, and loss of appetite; fatigue; exercise intolerance (related to fatigue and shortness of breath); insomnia; pain (chest and others); mood disturbances (mainly depression and anxiety); and cognitive dysfunction (brain fog, memory problems).
Women with heart failure report a wider range of symptoms, are more likely to have depression and anxiety , and report a lower quality of life compared to men with heart failure. As with a heart attack, women are more likely than men to report different symptoms. In heart failure, women report nausea, palpitations, and digestive changes, as well as increased pain levels (in other areas of the body, not just the chest), swelling, and sweating.
"Monitoring symptoms on a spectrum , compared to present or not present, 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 said. “Ultimately, we have work to do in terms of determining who needs more frequent monitoring or intervention to avoid poor heart failure outcomes.”
Valve disease
Heart valve disease is a common cause of heart failure and shares the symptom of shortness of breath. Problems with the heart valves (the leaflet-like structures that control blood flow between the chambers of the heart) include narrowed or hardened valves (stenosis), valves that close incorrectly (prolapse), allowing blood to flow backwards (regurgitation ) or incorrectly formed valves (atresia).
In mild cases of valve disease, people may have no symptoms for years and then progressively develop more symptoms similar to those associated with heart failure. Valve disease can also cause high blood pressure in the lungs or pulmonary hypertension. One of the most serious and common forms of valve disease is aortic stenosis , which occurs when the aortic valve narrows and restricts blood flow from the heart.
Women with aortic stenosis report shortness of breath, exercise intolerance, and physical frailty more frequently than men, and are more likely to have lower scores on a standard classification system for heart failure, known as the Association Functional Classification . from the Heart of New York. Men with valve disease are more likely to report chest pain than women with valve disease.
stroke
A stroke occurs when a blood vessel to the brain becomes blocked or burst, and usually causes recognizable symptoms that call for emergency help. To recognize stroke symptoms that require immediate medical attention, the American Stroke Association recommends that everyone remember the acronym FAST for Face Drooping, Weakness in Arms, Slurred Speaking, Time to Call 9-1. 1. Other stroke symptoms include confusion, dizziness, loss of coordination or balance, and visual changes . Recognizing the symptoms of stroke is critical, as immediate treatment can help prevent or reduce the chance of long-term disability or death.
Women who experience a stroke are more likely than men to have other, less familiar symptoms in addition to the common ones . These symptoms include headache, altered mental status, coma, or stupor . A stroke can also affect thinking, which, in turn, can affect an individual’s ability to recognize new or worsening symptoms.
After a stroke, some symptoms may persist and require ongoing care, whether these symptoms require rehabilitation or develop into disabilities. Post-stroke evaluation should include assessment of anxiety, depression, fatigue, and pain. Post-stroke pain can take months to develop, with most reports occurring between 4 and 6 months after the stroke.
Rhythm disorders
Rhythm disorders, or arrhythmias , are often described as the sensation of an abnormal heartbeat or palpitations that may be irregular, rapid, throbbing, or choppy. Other symptoms include fatigue, shortness of breath and dizziness, all of which are shared with other cardiovascular diseases. Less commonly, some people with heart rhythm disorders may experience chest pain, dizziness, fainting or near-fainting, and anxiety.
Women and young adults with rhythm disorders are more likely to experience palpitations , while men are more likely to experience no symptoms. Older adults are more likely to experience rare symptoms or no symptoms at all. Differences in symptoms have also been found among people of various racial and ethnic groups. Data indicates that black adults report experiencing more palpitations, shortness of breath, exercise intolerance, dizziness, and chest discomfort compared to Hispanic or white people.
Vein and artery disease
Peripheral arterial disease, or PAD, affects the arteries in the lower extremities and reduces blood supply to the legs. People with PAD may have no symptoms or may develop the classic symptom of claudication, which is pain in one or both calf muscles that occurs when walking and goes away with rest. However, pain in other parts of the legs and in the feet and toes are the more common symptoms of PAD rather than pain in the calf. PAD with symptoms is associated with an increased risk of heart attack and stroke, and men are at higher risk than women.
“Measurement of vascular symptoms includes assessment of quality of life and activity limitations, as well as the psychological impact of the disease,” Jurgens said. “However, existing measures often rely on physician assessment rather than self-reported symptoms and symptom severity.”
Depression occurs frequently among people with PAD, especially women and people who are older or from various racial and ethnic groups . Depression is also more likely to occur among people with more severe PAD.
Peripheral vein disease (PVD), like PAD, may not cause symptoms or may cause leg pain. Typical leg-related symptoms include leg pain and discomfort, heaviness or tightness in the legs, fatigue, cramps, restless legs syndrome, and skin irritation. In one study, adults younger than 65 were more likely than older adults to report pain, heaviness, discomfort, and fatigue. Vein disease symptoms sometimes occur even when there are no visible signs of the condition .
Sex differences in vein and artery disease are primarily seen among people with PAD. Women are more likely to report pain in places other than the calf muscle or no symptoms at all . Women’s symptoms are often complicated by the mistaken belief that PAD is more common among men or the symptoms are confused with those of other common conditions, such as osteoarthritis. PAD is also more likely to progress rapidly in women and affect quality of life.
Other factors that influence symptoms
National survey data show that people with heart disease have about twice the rate of depression compared to people without any medical conditions (10% vs. 5%). A 2014 American Heart Association scientific statement suggested that depression should be considered a risk factor for worse outcomes after an acute coronary syndrome event or diagnosis.
The current statement highlights that people with persistent chest pain, people with heart failure, as well as stroke survivors and people with peripheral artery disease often have depression and/or anxiety . Additionally, cognitive changes after a stroke can affect how and whether symptoms are experienced or noticed. The writing group recommends periodic assessments of cognitive function and depression levels throughout the course of any cardiovascular disease because they have a strong influence on a person’s ability to detect symptoms and any changes in their condition.
“Symptom relief is an important part of managing cardiovascular disease,” Jurgens said. “It is important to recognize that many symptoms vary in their onset or severity over time, that women and men often experience symptoms differently, and that factors such as depression and cognitive function can affect detection and reporting.” of the symptoms. “Monitoring and measuring symptoms 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.”
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing; the Hypertension Council; and the Stroke Council.
