Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001

Is severity of chest pain a cue for women and men to recognize acute myocardial infarction symptoms as cardiac in origin?

Recognizing symptoms as cardiac in origin is associated with the prompt seeking of medical care in patients with acute myocardial infarction (AMI). Therefore, the authors compared the symptom attribution of men and women experiencing AMI and examined factors associated with cardiac attribution by sex. In a cross-sectional study, a total of 1059 AMI patients were consecutively recruited across 5 countries. A structured interview was performed during hospitalization. Approximately 40% of both men and women interpreted their symptoms as cardiac in origin. In men, a history of coronary heart disease (CHD) and chest pain severity were significantly associated with symptom interpretation as cardiac in origin (odds ratio [OR], 4.0; 95% confidence interval [CI], 2.9-5.6; OR, 2.0; 95% CI, 1.4-2.7, respectively). In women, a history of CHD was also significantly associated with symptom interpretation as cardiac in origin (OR, 4.95; 95% CI, 2.39-10.25), but not severity of chest pain. As opposed to men, severe chest pain may not be a cue for women to interpret their symptom as cardiac in origin. Education and counseling must take sex differences into account to be effective.

Korean Immigrants’ Knowledge of Heart Attack Symptoms and Risk Factors

PURPOSE

This study assessed the knowledge of heart attack symptoms and risk factors in a convenience sample of Korean immigrants.

METHOD

A total of 116 Korean immigrants in a Midwestern metropolitan area were recruited through Korean churches and markets. Knowledge was assessed using both open-ended questions and a structured questionnaire. Latent class cluster analysis and Chi-square tests were used to analyze the data.

RESULTS

About 76% of the sample had at least one self-reported risk factor for cardiovascular disease. Using an open-ended question, the majority of subjects could only identify one symptom. In the structured questionnaire, subjects identified a mean of 5 out of 10 heart attack symptoms and a mean of 5 out of 9 heart attack risk factors. Latent class cluster analysis showed that subjects clustered into two groups for both risk factors and symptoms: a high knowledge group and a low knowledge group. Subjects who clustered into the risk factor low knowledge group (48%) were more likely than the risk factor high knowledge group to be older than 65 years, to have lower education, to not know to use 911 when a heart attack occurred, and to not have a family history of heart attack.

CONCLUSION

Korean immigrants' knowledge of heart attack symptoms and risk factors was variable, ranging from high to very low. Education should be focused on those at highest risk for a heart attack, which includes the elderly and those with risk factors.

Craniofacial pain as the sole symptom of cardiac ischemia

BACKGROUND

Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient's life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin.

METHODS

The authors prospectively selected consecutive patients (N = 186) who had had a verified cardiac ischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail.

RESULTS

Craniofacial pain was the only complaint during the ischemic episode in 11 patients (6 percent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 percent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear region and teeth. Craniofacial pain was pre-ponderantly manifested in female subjects (P = .031) and was the dominating symptom in both sexes in the absence of chest pain.

CONCLUSIONS

Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain.

CLINICAL IMPLICATIONS

Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment.

Public perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London

INTRODUCTION

The lay public have limited knowledge of the symptoms of myocardial infarction ("heart attack"), and inaccurate perceptions of cardiac arrest survival rates. Levels of CPR training and willingness to intervene in cardiac emergencies are also low.

AIMS

To explore public perceptions of myocardial infarction and cardiac arrest; investigate perceptions of cardiac arrest survival rates; assess levels of training and attitudes towards CPR, and explore the types of interventions considered useful for increasing rates of bystander CPR among Greater London residents.

METHODS

A quantitative interview survey was conducted with 1011 Greater London residents. Eight focus groups were also conducted to explore a range of issues in greater depth and validate trends that emerged in the initial survey.

RESULTS

Chest pain was the most commonly recognised symptom of "heart attack". Around half of the respondents were aware that a myocardial infarction differs from a cardiac arrest, although their ability to explain this difference was limited. The majority overestimated that at least a quarter of cardiac arrest patients in London survive to hospital discharge. Few participants had received CPR training, and most were hesitant about performing the procedure on a stranger.

CONCLUSIONS

Awareness and knowledge of CPR, and reactions to cardiac emergencies, reflect relatively low levels of CPR training in London. Publicising cardiac arrest survival figures may be instrumental in prompting members of the public to train in CPR and motivating those who have been trained to intervene in a cardiac emergency.

Assisting Women to Learn Myocardial Infarction Symptoms

OBJECTIVE

The purpose of this study was to test how teaching format (factual versus storytelling) and restructuring the social norm of caring for others to caring for self affects how women learn to identify and respond to myocardial infarction (MI) symptoms.

DESIGN

The study was a randomized pretest posttest full factorial experiment.

SAMPLE

One hundred and thirteen women participated.

MEASURES

Before and after reading the intervention pamphlet, the women wrote all the MI symptoms that they knew and rated their intention to call 911 if symptoms occurred.

INTERVENTION

The women read one of the four MI pamphlets corresponding to the four conditions.

RESULTS

No significant effects for learning MI symptoms resulted from teaching format or social norms. Women learned three additional MI symptoms. All responded with high intention to call 911 if MI symptoms occurred.

CONCLUSIONS

Women can learn additional MI symptoms from reading a brief pamphlet about MI symptoms. Use of a storytelling format and the social norm of caring for self might not impact how many MI symptoms women learn. Studies using audiovisuals and larger samples are needed to clarify whether storytelling format and the social norm of caring for self-impact learning MI symptoms.

Using behavioral risk factor surveillance data for heart disease and stroke prevention programs

An effective state heart disease and stroke prevention program must be able to monitor changes in heart disease and stroke risk factors of the state population. The Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey, has been an important source for monitoring health-related factors and evaluating the success of programs. The BRFSS currently includes modules on hypertension and cholesterol screening and awareness, cardiovascular disease preventive practices, and recognition of the signs and symptoms of heart attack and stroke as well as relevant modules on fruit and vegetable intake, physical activity, tobacco use, and diabetes. Publication topics included monitoring risk factors and clinical services, assessing progress toward national goals, assessing health disparities, and health status and health-related quality of life issues. States have used the BRFSS data for monitoring health risks in the state, assessing state and national health objectives, determining and providing data for public health campaigns, providing information for legislative proposals, and providing information that helps to initiate collaboration. Major methodologic issues involve validating self-reported data against direct measurement and assessing the effects of changes in telecommunications. As Centers for Disease Control's (CDC) national heart disease and stroke prevention program and each state health department program develop, state and even local level data will become more important to measure the burden of disease and program impact. State heart disease and stroke prevention programs are encouraged to work closely with state BRFSS coordinators to obtain vital information to measure the burden of heart disease and stroke in their state and to be able to measure program impact on addressing the first and third leading causes of death in the U.S.

Understanding Treatment-Seeking Delay in Women with Acute Myocardial Infarction: Descriptions of Decision-Making Patterns

• Background Women delay seeking treatment for symptoms of acute myocardial infarction longer than men delay. Women’s delay time has not been thoroughly characterized.

• Objectives To qualitatively describe the period between the onset of symptoms of myocardial infarction and enactment of the decision to seek care (decision time) and to identify common patterns of cognitive, affective, and behavioral responses to the symptoms (decision trajectories).

• Methods In this qualitative study, 52 women were asked in semistructured interviews to describe the symptoms and related thoughts, decisions, and actions from the onset of symptoms of myocardial infarction to arrival at the hospital. Narrative analysis was used to examine the stories and to identify patterns of decision-making behavior.

• Results Six common patterns of behavior during the decision time were identified: knowing and going, knowing and letting someone take over, knowing and going on the patient’s own terms, knowing and waiting, managing an alternative hypothesis, and minimizing. The patterns were further grouped as knowing or managing. Women in the 2 groups (knowing and managing) differed primarily in their awareness and interpretations of the symptoms and in their patterns of behavior in seeking treatment.

• Conclusions Women’s delay in seeking treatment for symptoms of myocardial infarction can be categorized into distinct patterns. Clinicians can use knowledge of these patterns to detect responses and situations that can decrease decision time in future cardiac events and to educate women about how to respond to cardiac symptoms.