epigastric pain


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epigastric pain

Etymology: Gk, epi, above, gaster, stomach; L, poena, penalty
pain in the upper middle part of the abdomen.

acute myocardial infarction

Cardiology The abrupt death of heart muscle due to acute occlusion or spasm of the coronary arteries Epidemiology ±1.5 million MIs/yr–US, 75,000 AMI follow strenuous physical activity, of whom13 die; ±14 of all deaths in the US are due to AMIs; > 60% of the AMI-related deaths occur within 1 hr of the event; most are due to arrhythmias, in particular ventricular fibrillation Triggers Heavy exertion in ±5% of Pts, which is inversely related to Pt's habitual physical activity Etiology Occlusion of major coronary artery–CA, in a background of ASHD, due primarily to the plugging of the vessel with debris from an unstable plaque–see Uncomplicated plaque Clinical Main presenting symptom–retrosternal chest pain accompanied by tightness, discomfort, & SOB; cardiac pain often radiates to the arm & neck, and less commonly to the jaw; the pain of AMI generally is. not relieved with nitroglycerin, in contrast to esophageal pain, which is often identical in presentation, and may respond, albeit slowly, to nitroglycerin; the characteristic clinical picture notwithstanding, there is a high rate of false negative diagnoses of AMIs Diagnosis Clinical presentation, physical examination, EKG–sensitivity in diagnosing AMI is 50–70%, and is lower in lateral MIs than in anterior and inferior MIs; CXR may demonstrate left ventricular failure, cardiomegaly Echocardiography M-mode, 2-D & Doppler Radioisotopic studies Radionuclide angiography, perfusion scintigraphy, infarct-avid scintigraphy, & PET can be used to detect an AMI, determine size & effects on ventricular function, and establish prognosis; a radiopharmaceutical, 99mTc-sestamibi, has become the perfusion imaging agent of choice, given its usefulness for measuring the area of the myocardium at risk for AMI, and for recognizing the myocardium salvaged after thrombolytic therapy Other imaging techniques–eg, CT, and MRI Lab CK-MB, troponin I DiffDx AMI is the most common cause of acute chest pain in older adults, other conditions must be excluded–Prevention ↓ Smoking, ↓ cholesterol, ↓ HTN; ↑ aerobic exercise; influence of other factors-eg maintaining normal body weight, euglycemic state in diabetes, estrogen-replacement therapy, mild-to-moderate alcohol consumption, effect of prophylactic low-dose aspirin-on incidence of AMI is less clear. See AIMS, ASSET, EMERAS, EMIP, GISSI, GISSI-2, GUSTO-1, INJECT, ISIS-2, ISIS-3, LATE, MITI-1, MITI-2, RAPID, TAMI-5, TAMI-7, TEAM-2, TIMI-2, TIMI-4, Trial.
Differential diagnosis of acute myocardial infarction
Arm pain
Myocardial ischemia, cervical/thoracic vertebral pain, thoracic outlet syndrome
Epigastric pain
Myocardial ischemia, GI tract–esophagus, peptic ulcers, pancreas, liver disease–cholecystitis, hepatic distension, pericardial pain, pneumonia
Retrosternal pain
Myocardial ischemia, aortic dissection, esophageal pain, mediastinal lesions, pericardial pain, PTE
Shoulder pain
Myocardial ischemia, cervical vertebra, acute musculoskeletal lesions, pericardial pain, pleuritis, subdiaphragmatic abscess, thoracic outlet syndrome
.

epigastric pain

Pain located between the xiphoid process and the umbilicus. It may suggest a problem in one of many different organs, including the stomach, pancreas, gallbladder, small or large bowel, pleura, or heart.
Synonym: gastralgic pain See: cardialgia
See also: pain
References in periodicals archive ?
The symptoms of HELLP syndrome include epigastric pain, nausea and/or vomiting, non-specific viral illness type symptoms, visual disturbances, headache, bleeding from the gums, jaundice, and neck or shoulder pain.
A total of 52 had epigastric pain syndrome, 122 had postprandial distress syndrome, and 17 had both disorders.
epigastric pain of severe intensity (3) occurring after about four days of treatment, and associated in one case with dyspnoea; somnolence of moderate intensity (1) and headache of mild intensity (1).
May cause a dull epigastric pain indicating acute gastritis.
A 42-year-old man, known to be an alcoholic, presented with acute severe epigastric pain and vomiting.
A 77-year-old female immigrant from South America sought medical attention at a hospital clinic due to epigastric pain and diarrhea.
A 60-year-old man presented with acute onset epigastric pain following an alcohol drinking binge.
Across the varying age groups, weekly symptoms (heartburn, epigastric pain and regurgitation) were reported 2% to 8% of the time.
A 64-year-old African-American female came to our facility because of a three day history of epigastric pain.
Resolution of aspirin-associated upper GI symptoms such as epigastric pain, burning and discomfort, as well as heartburn and bloating, was significantly higher with Nexium(R) than placebo (p<0.
It may also be expressed as nausea, vomiting, epigastric pain, diaphoresis, or cardiac arrhythmias.