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["Abdominal" variant of myocardial infarction: clinical features and diagnostic errors at the prehospital stage]
Abstract:
The results of prehospital diagnosis of myocardial infarction (MI) were studied in 1500 patients. The onset of MI was abdominal, gastralgic, and dyspeptic in 1.7, 1.3, and 0.4%, respectively. Abdominal MI differed from typical (anginal) MI in the relative predominance of old patients and women, late referrals to doctors, a high incidence of large and primary MI, worse prognosis. Hospital mortality in anginal and abdominal MI was 13.9 and 50.0% (p < 0.01), respectively. The rates of untimely diagnosis of anginal and abdominal MI were 13.4 and 25.0% and those of hyperdiagnosis were 19.9 and 31.8%, respectively. Prognosis in the hypodiagnosis of abdominal MI was worse than that in its hyperdiagnosis.
Insights
Abdominal myocardial infarction (MI) presents atypically, affecting older women more often and leading to worse outcomes. Early diagnosis is crucial, as delayed recognition of abdominal MI significantly worsens prognosis.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Accuracy
Background:
- Myocardial infarction (MI) diagnosis can be challenging, particularly with atypical presentations.
- Prehospital diagnosis accuracy is critical for patient outcomes.
Observation:
- A study of 1500 patients revealed that 1.7% of myocardial infarctions presented with abdominal symptoms.
- Abdominal MI predominantly affected elderly women, involved delayed medical attention, and frequently presented as large or primary events.
Findings:
- Hospital mortality for abdominal MI was 50.0%, significantly higher than the 13.9% for typical anginal MI (p < 0.01).
- Untimely diagnosis rates were higher for abdominal MI (25.0%) compared to anginal MI (13.4%).
- Hyperdiagnosis rates were also elevated for abdominal MI (31.8%) versus anginal MI (19.9%).
Implications:
- Atypical presentations like abdominal MI require heightened clinical suspicion for timely diagnosis.
- Improved diagnostic strategies are needed to reduce mortality associated with abdominal MI.
- Prognosis is worse with underdiagnosis (hypodiagnosis) of abdominal MI compared to overdiagnosis (hyperdiagnosis).