People with kidney disease have a somewhat different symptom profile when they present with acute myocardial infarction than those without kidney disease, reported Dr. Jonathan Sosnov of Tufts-New England Medical Center, Boston, and his associates.
More patients with kidney disease die from cardiovascular causes than from any other cause. “Accurate and rapid diagnosis of MI in these high-risk patients might decrease their risk for subsequent morbidity and mortality by providing definitive treatment in a more timely manner,” the investigators said.
They reviewed data from a large, ongoing prospective epidemiologic study of MI to examine whether kidney disease might alter the symptom profile of MI, much as diabetes recently has been shown to do. They analyzed the medical records of 4,482 patients hospitalized for MI at 11 medical centers in the Worcester, Mass., area in 1997, 1999, 2001, and 2003.
Patients with kidney disease were significantly less likely to report chest pain as their chief complaint. Only 44% presented with chest pain, compared with 72% of patients without kidney disease, Dr. Sosnov and his associates said (Am. J. Kidney Dis. 2006;47:378–84). Similarly, patients with kidney disease were significantly less likely to complain of arm pain, numbness or tingling in the arm or hand, shoulder pain, jaw pain, or neck pain.
Patients with kidney disease were significantly more likely to report shortness of breath as their chief complaint. A total of 26% presented with shortness of breath, compared with only 10% of patients without kidney disease.
The reasons for these differences in presentation remain unknown and “need to be explored further, given the high incidence of [acute myocardial infarction] in patients with kidney disease,” the researchers said.
“To the best of our knowledge, this is the first report to describe how kidney disease may impact on the symptoms” of acute MI, they added.
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