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Texas Health Dallas Researchers Publish Major Study Examining Connection Between Nausea and Heart Attacks
12/03/2009

DALLAS — Researchers at Texas Health Presbyterian Hospital Dallas are investigating what symptoms could help doctors better spot heart attacks and if certain symptoms might indicate different types of heart attacks. Their most recent work, “Relation of Nausea and Vomiting in Acute Myocardial Infarction to Location of the Infarct,” appears in the December edition of the American Journal of Cardiology.

Dr. Mark Feldman
Dr. Feldman has authored other major studies in recent years. Under his leadership, Texas Health Dallas was part of a landmark study last year that shed light on how best to assess and treat hospital patients for a potentially deadly-type of blood clot. Click here to read about that research.

According to the findings, almost two-thirds of heart attack patients suffer nausea when arriving in the ER — but whether they have an upset stomach does not indicate where cardiac blood flow is blocked, said senior author Dr. Mark Feldman, chair of internal medicine at Texas Health Dallas and director of the hospital’s internal medicine residency program.

“Previous studies had suggested nausea and vomiting may be more common in patients with heart attacks in one part of the heart, but we found that there’s not a strong connection,” said Feldman, a master of the American College of Physicians. “By studying what these symptoms mean and better understanding the signs of heart attacks, we’re working toward better treatment of this disease.”

A heart attack, or acute myocardial infarction (AMI), occurs when normal blood supply to the heart muscle is interrupted. The blockage can happen in one or more of the heart’s coronary arteries. Even a brief interruption of blood flow, often caused by a buildup of plaque inside artery walls (called atherosclerosis), can kill or cause permanent damage to the heart.

Almost two million people in the United States suffer heart attacks each year — with more than 500,000 deaths. Heart attacks are one of the leading causes for hospital admissions in the U.S.

“Heart attacks can kill or cause major long-term health problems,” said Dr. John Harper, a study co-author and cardiologist on the medical staff at Texas Health Dallas, as well as medical director of the hospital’s Heart Failure Unit. “It’s a devastating event for a patient and their family. Our mission is to learn more about the signs and symptoms so that we can better care for these patients and, in some cases, prevent damage to the heart altogether.”

Nausea and vomiting occur frequently in patients suffering heart attacks. Previous studies have reported that nausea and vomiting are much more common in heart attacks that involve the inferior, or back, portion of the left ventricle. These are not the most deadly type of heart attack.

Anterior heart attacks — the most dangerous types of heart attacks — often happen when the left coronary artery, called the “widow maker,” is blocked.

The research project was a cohort study of 180 patients who had been admitted to the hospital for two common types of heart attacks. Of those patients, 108 (60 percent) were diagnosed with inferior wall AMI, and 72 (40 percent) with anterior wall AMI. Of the patients with inferior AMI, 6 percent did not present with any chest pain, compared with 10 percent in the anterior AMI group. Nausea was reported in nearly 2 out of every 3 heart attack, regardless of heart attack types, with vomiting reported in nearly 1 out of every 3 cases.

“Our findings tell us that we should never make assumptions about the type of heart attack or where it’s located based on nausea,” Feldman said. “Part of what interested us is that a slew of other studies had concluded that there was a connection, and we wanted to test the validity of those findings. Most importantly, we’re searching for better ways to care for the people of North Texas who suffer from heart disease.”

The vast majority of patients in both groups were treated with a percutaneous coronary intervention (PCI), often called a cardiac “cath procedure.” It’s the most advanced intervention for heart-attack patients who do not respond to medications. The procedure, offered only at major medical centers with advanced cardiac programs, involves inserting a wire into the leg artery of a heart-attack patient, then guiding it through the maze of abdominal and thoracic arteries to the site of the blockage. A tiny balloon on the tip of the wire is then inflated to open the coronary artery and restore blood flow to the heart. A coronary stent is placed in the artery to keep the blood vessel open.

The success of these advanced procedures is based, in part, on how quickly the treatments are administered, Harper said. But the procedure can’t be performed until a proper diagnosis is made.

“Quickly diagnosing a heart attack is paramount. Time is heart muscle,” Harper said. “That’s why we want to know everything we can about the symptoms a patient presents with at the hospital. That’s when the treatment begins.”

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 866-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/dallas.

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