Chest Pain as a presenting complaint in patients with acute myocardial infarction (AMI)
Muhammad Ajmal Malik1, Shahzad Alam Khan2, Sohail Safdar3
1Dr. Muhammad Ajmal Malik, MBBS, MD, Senior Registrar, Nishtar Hospital Multan, Pakistan.
Insights
Severe and prolonged chest pain, particularly in males aged 41-70 with radiation to the left shoulder, neck, and jaw, is highly indicative of acute myocardial infarction (AMI). Vigilant history taking is crucial for diagnosis.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Chest pain is a common symptom with diverse etiologies.
- Differentiating cardiac from non-cardiac chest pain is clinically significant.
Purpose of the Study:
- To investigate the specific characteristics of chest pain in patients diagnosed with acute myocardial infarction (AMI).
- To identify key features of chest pain that may aid in the early diagnosis of AMI.
Main Methods:
- A descriptive study involving 331 patients admitted with AMI.
- Data collected over one year (June 2011-June 2012) using non-probability purposive sampling.
- Statistical analysis performed using SPSS-11.
Main Results:
- 93.1% of AMI patients presented with chest pain.
- The most common pain locations were precordial (38.4%), retrosternal (34.7%), and epigastric (17.5%).
- Severe pain (84.9%) lasting over 20 minutes (90%) was frequent, with radiation patterns noted in a significant proportion.
Conclusions:
- Chest pain characteristics can overlap between cardiac and non-cardiac conditions.
- Detailed evaluation of chest pain history is vital for diagnosis.
- Specific patterns like severe, prolonged precordial pain radiating to the left shoulder, neck, and jaw in middle-aged males strongly suggest AMI.
Objective:
To study various characteristics of chest pain in acute myocardial infarction patients.
Methodology:
A total of 331 patients of AMI admitted at Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan, irrespective of the age and gender, were included in this study. The study duration was one year starting from June 2011 to June 2012. Non-probability purposive sampling technique was used in this descriptive study. Informed consent to participate in this study was taken. Data were entered and analyzed using SPSS-11.
Results:
A total number of 331 patients with AMI were included in the study. Mean age was 54.99±11.25 years with minimum age 20 years and maximum age 90 years. It included 264(79.8%) male and 67(20.2%) female patients with male to female ratio of 3.9:1. Out of these 331 patients 308 (93.1%) patients reported chest pain as the presenting complaint. Remaining 23(6.9%) presented with clinical features other than chest pain. There were 127(38.4%) patients with pre-cordial chest pain, 115(34.7%) had retrosternal chest pain, 58(17.5%) were having epigastric pain. Severe chest pain was seen in 281(84.9%) patients while 26(7.9%) had only mild chest discomfort. Radiation of the pain to shoulder, neck and jaw was seen in 75 (22.7%) patients. In 42(12.7%) patients, pain radiated to both sides of chest. Another 55(16.6%) patients had pain radiation to chest, shoulder, upper arm and ulnar side of left forearm. Chest pain radiation to interscapular region along with both sides of chest was present in 10(3.0%) patients. In 11(3.3%) patients' pain radiated only to left side of chest. Pain persisting for >20 minutes was reported by 298 (90%) patients while only 10(3.1%) had pain persisting for <20 minutes.
Conclusion:
There is considerable overlap in chest pain of cardiac as well as non cardiac causes. However, vigilant evaluation of characteristics of chest pain in history taking may help to overcome this dilemma. Severe and prolonged precordial chest pain in a male patient between the age of 41-70 years, with pain radiation to left shoulder, neck and jaw is highly suggestive of AMI.
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