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Vomiting as a diagnostic aid in acute ischaemic cardiac pain

D A Ingram, R A Fulton, R W Portal

    British Medical Journal
    |September 6, 1980
    PubMed

    Insights

    Vomiting before pain relief in cardiac patients often indicates transmural myocardial infarction. Early vomiting with cardiac pain suggests a 90% likelihood of transmural infarction, aiding diagnosis.

    Area of Science:

    • Cardiology
    • Emergency Medicine
    • Diagnostic Medicine

    Background:

    • Prolonged ischemic cardiac pain is a common emergency admission symptom.
    • Vomiting is a recognized but inconsistently reported symptom associated with acute cardiac events.
    • Differentiating types of myocardial infarction is crucial for timely and appropriate treatment.

    Purpose of the Study:

    • To investigate the incidence of vomiting prior to analgesic administration in patients with ischemic cardiac pain.
    • To determine the correlation between early vomiting and the presence of transmural myocardial infarction.
    • To assess the diagnostic value of vomiting in predicting transmural infarction.

    Main Methods:

    • Prospective study of 109 emergency hospital admissions for prolonged ischemic cardiac pain.
    • Categorization of patients based on infarction type: transmural, non-transmural necrosis, or coronary insufficiency without necrosis.
    • Recording of vomiting incidence before analgesic administration.

    Main Results:

    • Vomiting occurred in 43% of patients with transmural myocardial infarction (58% anterior, 41% inferior).
    • Vomiting was rare (1 patient each) in patients with non-transmural necrosis or coronary insufficiency without necrosis.
    • Early vomiting associated with cardiac pain predicted transmural infarction in 90% of cases.

    Conclusions:

    • Early vomiting in the context of ischemic cardiac pain is a strong indicator of transmural myocardial infarction.
    • The presence or absence of vomiting can help differentiate transmural infarction from other cardiac conditions.
    • This finding can aid emergency physicians in rapid diagnosis and risk stratification.

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