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

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.

Keywords

acute coronary syndrome (ACS) / throat discomfort (TD) / throat pain / cardiology departments / non-cardiologic physicians

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (Nos. 81822011 and 81771013) and Clinical Research Plan of SHDC (No. SHDC2020CR4083 ).

Compliance with ethics guidelines

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, and Yilai Shu declare that they have no competing interests. This research was conducted in accordance with the ethical standards of the Internal Review Board of Eye & ENT Hospital, Fudan University.

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