Add dyspnea, or difficulty breathing, to the growing list of risk factors that could signal heart trouble.

The Study

A team of researchers divided 17,991 patients in to five groups based on the number and type of symptoms-no symptoms, two different forms of angina, chest pain not caused by angina, and dyspnea alone.

After an average follow-up of nearly three years, the researchers found that patients who had dyspnea but no other signs of heart problems were at more than twice the risk of death as those who had angina-chest pain that is the most recognized symptom of heart disease.

Lessons Learned

The lesson for people is that when they visit a doctor they should be sure to mention any shortness of breath, says senior researcher Dr. Daniel S. Berman, director of cardiac imaging at Cedars-Sinai Medical Center in Los Angeles.

"The patient often doesn't think of it as a symptom," Berman notes. But when signs of a heart problem are discovered, "and we ask whether there is shortness of breath, they say 'yes.' "

Dyspnea has many causes, and physicians routinely ask people if they have trouble breathing, says Dr. Alan Rozanski, director of nuclear cardiology at St. Luke's-Roosevelt Hospital in New York City, and another member of the research team. He says that trouble breathing is often a tip-off to the physician that a patient may have some underlying lung disease, maybe even heart failure.

But until now, only a few small studies have looked at whether dyspnea is a predictor of cardiac events, Rozanski says.

The bottom line: "People who have developed shortness of breath without any obvious lung problem should consider whether it is of cardiac origin," Berman says.

A Sign Of Trouble

For years, cardiologists have focused on chest pain as the primary symptom" of heart problems, Rozanski says. They consider a variety of other factors as well, including depression, lack of sleep and fatigue. This study increases interest in looking at other factors.

"We should think of shortness of breath not only in terms of lung disease," Rozanski adds. "We might need to screen a little more deeply for coronary artery disease. someone with dyspnea might have a heightened need to undergo stress testing or other screening."

Rozanski says the study is already affecting decisions on stress testing in his practice. Now, when evaluating the need for an individual to have a stress test, he includes such factors as age, chest pain and gender (men are more likely to be referred for the test). "If someone has an intermediate risk, the presence of shortness of breath might tip me over" to recommend a stress test, he says.

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