Reduced range of facial expression indicates serious heart, lung disease

July 14, 2014, British Medical Journal

Patients with serious heart and lung conditions don't have the normal range of facial expressions, particularly the ability to register surprise in response to emotional cues, finds preliminary research published online in Emergency Medicine Journal.

This finding could be used to help busy emergency care doctors decide whom to prioritise for treatment, and gauge who really needs often costly and invasive tests, suggest the researchers.

And it adds scientific credibility to the rapid visual assessment doctors make of how sick someone is, formally known as gestalt pretest probability, they say.

The researchers tested the diagnostic accuracy of reduced facial expression range in 50 adults with shortness of breath (dyspnoea) and chest pain in an emergency care department.

The briefly viewed three visual cues, designed to evoke an emotional response, on a laptop.

The computer webcam recorded their in response to each of these cues, which included a humorous cartoon, a close-up of a surprised face, and a picture of someone in tears.

These recordings were analysed, using the Facial Action Coding System (FACS), which scores changes in facial muscle activity, reflecting the extent of smiling, frowning, and surprise.

The patients were scanned to check for serious heart or lung disease, including (, unstable angina); a blood clot in the lung (pulmonary embolism); pneumonia; problems in the major (aortic) artery or gut; and new cancers, and monitored for 14 days.

During the monitoring period, eight (16%) patients developed serious heart or . Among the 42 considered not to have any serious health problem, two developed worsening chronic obstructive pulmonary disease, two developed heart failure; and one an irregular heart rhythm (atrial fibrillation).

The analysis of the webcam recordings showed that patients with chest pain and shortness of breath who had a potentially serious heart or lung condition had a significantly narrower range of facial expression in response to than those who did not have these health problems.

The difference in the ability to express surprise most strongly demarcated those with serious and lung problems from those without.

"We believe that due to the gravity of their illness, [these] patients may not have been able to process and respond to an emotional stimulus in the way that would be expected of most people under normal conditions," write the researchers.

They go on to say: "The ultimate goal of this work is to provide clinicians with a new physical finding that can be associated with a healthy state to avoid unnecessary [computed tomography] scanning," which could be added to the physical examination.

In an accompanying podcast, lead author Jeffrey Kline, says that there are several structured scoring systems to determine a patient's likelihood of developing a clot on the lungs, for example, but they are not always easy to remember or readily applicable to all patients.

And looking at patients is a key part of a doctor's bedside manner, he says, adding that as consultations by Skype become more common, the ability to read a patient's face may become even more important.

Explore further: Study finds advanced CT scanners reduce patient radiation exposure

More information: Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting, Emergency Medicine Journal, Online First, DOI: 10.1136/emermed-2014-203602

Related Stories

Study finds advanced CT scanners reduce patient radiation exposure

June 21, 2014
Computed tomography scans are an accepted standard of care for diagnosing heart and lung conditions. But clinicians worry that the growing use of CT scans could be placing patients at a higher lifetime risk of cancer from ...

Gender-specific research improves accuracy of heart disease diagnosis in women

June 16, 2014
Diagnosing coronary heart disease in women has become more accurate through gender-specific research that clarifies the role of both obstructive and non-obstructive coronary artery disease as contributors to ischemic heart ...

New test set to improve care for patients with suspected heart attack

May 2, 2014
Manchester researchers have developed a novel approach, called the Manchester Acute Coronary Syndromes Decision Rule, to more quickly and effectively diagnose heart attack in patients admitted to emergency departments.

Air pollution linked to irregular heartbeat and lung blood clots

June 4, 2014
Air pollution is linked to an increased risk of developing an irregular heartbeat—a risk factor for stroke—and blood clots in the lung, finds a large study published online in the journal Heart.

Detailed assessment of heart failure identifies patients needing pacemaker treatment (CRT)

June 10, 2014
By measuring how synchronised the heart chambers work together, it is possible to identify which patients with heart failure who benefit from pacemaker therapy, and which ones who do not. This is presented in a thesis to ...

Many breast cancer patients don't get treatment for heart problems

June 3, 2014
Only a third of older breast cancer patients saw a cardiologist within 90 days of developing heart problems, in a study presented at the American Heart Association's Quality of Care and Outcomes Research 2014 Scientific Sessions.

Recommended for you

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

Place of residence linked to heart failure risk

January 9, 2018
Location. Location. Location.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.