Blacks are more likely to describe the warning signs of heart attack as suffocation or a sharp, stabbing chest pain instead of the tightness in the chest and pain radiating down the arm that whites describe, a new study indicates.
And, because blacks do not perceive feelings of suffocation and sharp chest pain as heart-related, they often experience "dangerous delays" in getting to a hospital, North Carolina investigators reported today.
"Even physicians may miss the diagnosis if they are not alert to the different pain perceptions in heart attacks among blacks," said Dr. Ross Simpson, a University of North Carolina cardiologist and the study's principal investigator.
He presented his findings at a American Heart Association meeting in Anaheim, Calif.
"The study reinforces the point that pain is very subjective, and different racial and socio-economic groups are going to describe it differently," he said. "I think that in the past we have been fixated on how whites experience pain during heart attacks. By doing this, we may be missing other groups."
In a study of 83 men and women who had heart attacks, Simpson observed that blacks waited longer than whites with their pain symptoms before seeking medical treatment. Blacks delayed an average of 23 hours while whites waited an average of eight hours.
One-quarter of the blacks who had heart attacks postponed seeking help for longer than 24 hours, compared with 7.5 percent of the whites. In the study were 17 blacks and 66 whites.
A heart attack occurs when a blood clot forms and blocks an artery feeding the cardiac muscle. Today, hospitals administer drugs that break up the clots, but the therapy must be initiated within six to eight hours after chest pain is first felt.
If the therapy is excessively postponed, heart muscles die and the ability of the heart to pump blood is compromised.
"If someone delays coming into the hospital, the window of opportunity is lost. There is much less likelihood that we can dissolve the clot, so the damage to the heart becomes irreversible," Simpson said.
The researcher said he was surprised to find that one-fourth of these patients had symptoms of pain for a day or longer before coming to the hospital.
"The positive thing about the study is that it tells us there is a group of people we can target with our preventive efforts, and try to get them to come in earlier," he said.
The blacks in the study tended to have less education than their white counterparts, suggesting that economic or educational statusmay be related to pain perception, Simpson said.