Symptoms of cardiovascular problems run the gamut. Some – like chest pain during a heart attack or a droopy face during a stroke – are sudden and severe, while others last years with varying intensity. Factors such as sex, cognitive function and depression can complicate the recognition or diagnosis of symptoms.
In a new report, experts detail the latest knowledge on cardiovascular disease symptoms with the goal to improve patient care and identify where more research is needed.
"Symptoms are a big part of how we assess a patient when they come to see us in clinic and how we make decisions about what the best treatment is for an individual," said Megan Streur, a nurse practitioner at the Heart Institute at UW Medical Center in Seattle. "But at the same time, there's a lot that we still don't understand about the variability of symptoms in the same condition across different individuals."
Streur, also an assistant professor of nursing at the University of Washington, helped write the new scientific statement from the American Heart Association, published Thursday in its journal Circulation.
Part of the challenge of evaluating and studying symptoms is they're subjective, said Corrine Jurgens, an associate professor of nursing at Boston College and head of the panel that wrote the report.
An objective measure of heart health, such as blood pressure or heart rhythm, can be measured over and over and tracked over time. "But symptoms aren't like that," Jurgens said. "We have to have the patients tell us how they're feeling."
Health care professionals should consider factors that might affect which symptoms a person describes, the report says. For example, although chest pain is the most common symptom of a heart attack in both women and men, women are more likely to also experience nausea, shoulder pain and upper back pain.
With peripheral artery disease, a narrowing of the vessels that carry blood to the arms and legs, women are more likely than men to have no symptoms at all. But when they do, women's symptoms may be wrongly attributed to other conditions such as osteoarthritis, or even dismissed under the false assumption that peripheral artery disease is more common among men.
Such differences have consequences. "It's still the case that women are often diagnosed with illnesses later than they would have been diagnosed if they were men," said nurse scientist Christopher Lee, associate dean of research at Boston College and vice chair of the report's writing committee.
There are also differences in how people interpret symptoms based on cultural norms, the report said. And in terms of race, research shows Black people with a type of irregular heartbeat called atrial fibrillation experience more palpitations, shortness of breath and dizziness compared to white or Hispanic people with AFib.
But many measures of cardiovascular symptoms are based on studies of white men, Lee said. The report calls for more research on symptoms among different groups.
A person's mental health also can affect how they report symptoms. Depression and cardiovascular disease often coincide, Lee said, and that can lead to "a general blunting of someone's ability to detect what may otherwise be a very large change in their condition." Cognitive function also can affect symptom detection, making it important to regularly measure a patient's cognitive and depression levels, the report said.
Jurgens said more precise ways to track and evaluate symptoms are needed, both for the sake of research and to help health professionals better identify patients' needs. Lee agreed.
"A lot of cardiovascular research is focused on illness itself, and not really the human response to illness," he said. "So focusing on symptoms is very much capturing what the experience is like for the people living with these conditions."
While better measures are being designed and put into use, people with cardiovascular disease can take steps to ensure they're communicating their own experiences clearly.
Streur said it's important for patients to be open, to not minimize symptoms and to be specific. She said if you're seeing a health care professional about shortness of breath – a hallmark symptom of heart failure – think about: "When is this happening? Is there something that tends to trigger it? Is there a specific time of day that it's worse than others? Or if it's a rapid heart rate, when does it happen? How long does it last when it happens? How fast is it going?"
Reporting all of your symptoms, even though you might not connect them to your heart, is important, Jurgens said. Symptoms cluster, she said, and the different types of shortness of breath tell a health care professional different things. "If you can't lie flat, that is more problematic than shortness of breath with activity. Similarly, if you wake up from sleep acutely short of breath, that also tells us that there is a significant problem brewing."
Such details, Streur said, help health care professionals "figure things out as quick as possible and get people on the path to a treatment that's going to help them feel better."
Lee said that the report calls for moving the science forward in how symptoms are measured, but it also emphasizes the basics. "A good clinical assessment and very detailed inquiry into how the person is feeling living with the condition has always been important."
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