Atypical manifestations of acute coronary syndrome - throat discomfort: a multi-center observational study.

Yanqing Fang; Xiaoting Cheng; Wenhui Peng; Xueying Chen; Chunping Tang; Qiusheng Huang; Sihai WU; Yibo Huang; Fanglu Chi; Matthew R Naunheim; Huawei LI; Bing Chen; Yilai Shu

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Atypical manifestations of acute coronary syndrome - throat discomfort: a multi-center observational study.

Author: Yanqing FANG ¹ ; Xiaoting CHENG ¹ ; Wenhui PENG ² ; Xueying CHEN ³ ; Chunping TANG ⁴ ; Qiusheng HUANG ⁵ ; Sihai WU ⁶ ; Yibo HUANG ¹ ; Fanglu CHI ¹ ; Matthew R NAUNHEIM ⁷ ; Huawei LI ¹ ; Bing CHEN ⁸ ; Yilai SHU ⁹
Author Information

1. ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.
2. Department of Cardiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
3. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China. chen.xueying@zs-hospital.sh.cn.
4. Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, 210029, China.
5. Department of Otolaryngology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China.
6. Department of Otorhinolarynogology, The Second People's Hospital of Wuxi, Nanjing Medical University, Wuxi, 214002, China.
7. Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, 02114, USA.
8. ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China. bingchen@fudan.edu.cn.
9. ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China. yilai_shu@fudan.edu.cn.
Publication Type:Observational Study
Keywords: acute coronary syndrome (ACS); cardiology departments; non-cardiologic physicians; throat discomfort (TD); throat pain
MeSH: Acute Coronary Syndrome/etiology*; Dyspnea/etiology*; Humans; Pharyngitis/diagnosis*; Pharynx; Retrospective Studies
From: Frontiers of Medicine 2022;16(4):651-658
CountryChina
Language:English
Abstract: To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.