Prodromata of myocardial infarction and sudden death

A sample of 160 hospitalized, acute myocardial infarction patients and 138 individuals who died prior to hospitalization from acute coronary heart disease were studied to determine the incidence and duration of prodromal symptoms and action taken to cope with the symptoms. Seventy percent of the in-hospital subsample (IHS) and 64% of the out-hospital subsample (OHS) reported prodromata. The OHS reported a significantly longer median duration of symptoms than the IHS (29 versus 10.5 days). Sixty-seven percent of the IHS reported new or accelerated anginal symptoms as the most frequently occurring symptom, in contrast to 35% for the OHS. Twenty-seven percent of the IHS and 36% of the OHS consulted a physician about symptoms. Individuals in both subgroups, especially chronically diseased patients, considered their symptoms manageable. Likewise, when contacted, their physicians may have viewed these symptoms as manageable. Patients with a high risk of myocardial infarction and sudden death were significantly more likely to have consulted physicians during the prodromal phase than low-risk patients. A clearly delineated prodromal syndrome is needed so that both lay and medical communities can effectively respond to and intervene during the prodromal phase of acute myocardial infarction and sudden cardiac death.