1. ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200031, China; Institutes of Biomedical Sciences, Fudan University, Shanghai 200031, China 2. NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China 3. Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China 4. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China 5. Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China 6. Department of Otolaryngology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China 7. Department of Otorhinolarynogology, The Second People’s Hospital of Wuxi, Nanjing Medical University, Wuxi 214002, China 8. Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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.
Compressing of throat (i.e., obstruction, or choking)
9 (8.91%)
0 (0.00%)
0.002
Foreign body sensation
0 (0.00%)
34 (33.66%)
<0.001
Throat itch
1 (0.99%)
12 (11.88%)
0.002
Dry throat
0 (0.00%)
13 (12.87%)
<0.001
Sense of phlegm
0 (0.00%)
8 (7.92%)
0.004
Throat burning
0 (0.00%)
1 (0.99%)
0.316
Tab.2
Cardiac symptoms and past medical history information
ACS-TD group (n = 101)
TD group (n = 101)
P value
Cardiac symptoms
Chest tightness
47 (46.53%)
5 (4.95%)
<0.001
Dyspnea
14 (13.86%)
5 (4.95%)
0.030
Perspiring
34 (33.66%)
2 (1.98%)
<0.001
Rare symptomsc
8 (7.92%)
1 (0.99%)
0.017
History of chest pain
3 (2.97%)
3 (2.97%)
1.00
No cardiac symptoms
25 (24.75%)
90 (89.10%)
<0.001
Tab.3
Variables
Coefficientsa
SEb
P value
ORc
95% CI
Constant value
−1.875
2.190
0.392
0.15
−
Gender
0.681
0.619
0.271
1.98
0.59−6.64
Age
0.021
0.033
0.516
1.02
0.96−1.09
Chest tightness
2.111
0.683
0.002
8.26
2.16−31.52
Dyspnea
2.395
0.923
0.009
10.97
1.80−66.90
Perspiring
3.235
0.999
0.001
25.40
3.59−179.91
Exertional throat symptoms
4.397
0.934
<0.001
81.17
13.00−506.71
Severity of throat symptoms
0.047
0.384
0.902
1.05
0.49−2.23
Usefulness of medicine for pharyngitis
−3.016
0.602
<0.001
0.05
0.02−0.16
Tab.4
Unreferred patients (n = 25)
19 cases referred from ENT department and 57 cases first admitted to cardiology department (n = 76)
P value
Age (year, mean±SD)
55.24±8.54
59.00±10.46
0.107
Gender
Female
8 (32.00%)
30 (39.47%)
0.503
Male
17 (68.00%)
46 (60.53%)
Throat symptoms
Throat pain
20 (80.00%)
28 (36.84%)
<0.001
Throat distress
0 (0.00%)
32 (42.11%)
<0.001
Throat tightness (or constricting)
5 (20.00%)
12 (15.79%)
0.625
Compressing of throat (i.e., obstruction or choking)
2 (8.00%)
7 (9.21%)
0.854
Foreign body sensation
0 (0.00%)
0 (0.00%)
1.00
Throat itch
0 (0.00%)
1 (1.325)
0.654
Dry throat
0 (0.00%)
0 (0.00%)
1.00
Sense of phlegm
0 (0.00%)
0 (0.00%)
1.00
Throat burning
0 (0.00%)
0 (0.00%)
1.00
Cardiac symptoms
Chest tightness
9 (36.00%)
38 (50.00%)
0.223
Dyspnea
4 (16.00%)
10 (13.16%)
0.721
Perspiring
10 (40.00%)
24 (31.58%)
0.440
Rare symptomsb
2 (8.00%)
6 (7.89%)
0.987
History of chest pain
0 (0.00%)
3 (3.95%)
0.313
No cardiac symptoms
6 (24.00%)
19 (25.00%)
0.920
Past medical history
Hypertension
16 (64.00%)
52 (68.42%)
0.683
Smoking
5 (20.00%)
26 (34.21%)
0.181
Diabetes
3 (12.00%)
14 (18.42%)
0.457
Prior cardiovascular diseasec
0 (0.00%)
10 (13.16%)
0.056
History of pharyngitis
8 (32.00%)
2 (2.63%)
<0.001
Tab.5
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