Acute Myocardial Infarction Diagnosis | Health Information Encyclopedia


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ACUTE MYOCARDIAL INFARCTION DIAGNOSIS
Category: Cardiology Heart Health
Abstract : Chest Pain : • Usually lasts more than 20 minutes and often persists for several hours. The pain of infarction, however, can last for only 15 minutes, and, occasionally, fatal infarction is ushered in by only a few minutes of severe pain or even unheralded cardiac arrest. Infarction may be relatively silent, particularly in diabetic patients and in the elderly. • Typically retr

Chest Pain :
• Usually lasts more than 20 minutes and often persists for several hours. The pain of infarction, however, can last for only 15 minutes, and, occasionally, fatal infarction is ushered in by only a few minutes of severe pain or even unheralded cardiac arrest. Infarction may be relatively silent, particularly in diabetic patients and in the elderly.
• Typically retrosternal and across the chest.

• Variations of a crushing, vice-like, heavy weight on the chest and pressure, tightness, strangling, aching.
• At times, only a discomfort with an oppression and burning or indigestion-like feeling.
• May radiate to the throat, jaws, neck, shoulders, arms, scapulae, or the epigastrium. At times, pain is centered at any one of these areas (e.g., the epigastrium, left wrist, or shoulder, without radiation).
• Upper epigastric and lower chest pain believed to be gastroesophageal in origin without feelings of indigestion is not uncommonly caused by a heart attack.
• Usually builds up over minutes or hours, as opposed to aortic dissection, in which pain has an abrupt onset like a gunshot.

Associated symptoms and factors include the following:
• Diaphoresis, cold clammy skin, and apprehension (however, all of these symptoms may be absent).
• Shortness of breath, nausea, vomiting, dizziness.
• Women with acute MI often reveal atypical symptoms with low levels of chest pain or absence of pain. In one study, acute chest pain was absent in 43%; acute symptoms were shortness of breath (57.9%), weakness (54.8%), and fatigue (42.9%).
• Presyncope and, rarely, syncope may occur owing to bradyarrhythmias, especially in inferior MI.
• Occasionally there is no pain. A marked decrease in blood pressure with associated symptoms, along with electrocardiogram (ECG) findings, should suffice in making the diagnosis.
• Painless infarcts (in about 10% of patients), especially in diabetics or the elderly. In these patients, associated symptoms are often prominent and serve as clues to diagnosis.
• More than 30% of patients have a history of angina or prior infarction.
• Approximately 33% of patients with acute infarction have no major risk factors, which include death of a parent or sibling younger than age 55, cigarette smoking, hypertension, or diabetes; and more than 25% have cholesterol levels less than 5.2 mmol/L (200 mg/ dL). Importantly, absence of these factors should not influence the diagnosis.

Physical Signs
• Patient appears apprehensive, anxious, cold, clammy.
• Area of chest pain may be indicated with a clenched fist.
• Tachycardia 100–120 per minute. An increase in blood pressure owing to increased sympathetic tone is observed in approximately 50% of patients with anterior infarction.
• Bradycardia less than 60 beats per minute (BPM) and a decrease in blood pressure in about two-thirds of inferior infarcts; many of these patients become hypotensive, sometimes profoundly.
• S4 gallop is common; S3 and S4 if in HF or cardiogenic shock.
• Murmur of mitral regurgitation as a result of papillary muscle dysfunction.
• Crepitations, more prominent over the lower third of the lung fields, may be present.
• Elevated jugular venous pressure owing to left and right HF or a very high venous pressure in the presence of right ventricular infarction or cardiac tamponade.
• Frequently, there are no abnormal physical signs, and this finding in a patient with suggestive symptoms should not decrease the level of suspicion that the patient may have an MI.

Although sophisticated tests have evolved to improve diagnostic accuracy, they are of limited value in the era of thrombolysis and aggressive PCI. Thus, a relevant history and correct interpretation of the ECG are of paramount importance in the implementation of early thrombolytic therapy, or PCI, which will be of greatest benefit if instituted within 2 hours of symptom onset.

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