Retrosternal pain

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
References in periodicals archive ?
GEI can clinically present with acute esophageal obstruction, vomiting, upper gastrointestinal bleeding, and severe epigastric or retrosternal pain that radiates to the neck and shoulder and that can mimic cardiac pathology (6).
4) Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are overlapping symptoms of achalasia and BN.
1%) patients presented with regurgitation, retrosternal pain and odynophagia respectively.
Ten days post-admission the patient started complaining of a sharp retrosternal pain radiating to the left scapula, associated with pericardial friction rub along the lower left sterna border.
A month ago, the patient was hospitalized for retrosternal pain, shortness of breath, but also left side chest pain accompanied by left pleural friction rub and systemic inflammatory response (ESR of 84 mm, fibrinogen of 780 mg/dl, C-reactive protein of 27 mg/dl, leukocytosis of 13.
A healthy 20-year-old male who was never a smoker and with no history of trauma, drug abuse, or respiratory disease presented with retrosternal pain and dyspnea, preceded by a three-day history of irritative cough and odynophagia.
The patient, a male student, 17-year-old, was admitted to our emergency room with persistent retrosternal pain accompanied by sweat 2 h.
Achalasia cardia is a neuromuscular disorder of unknown aetiology, rarely described in children and adolescents: The symptoms include dysphagia, vomiting/ regurgitation of food, retrosternal pain, poor growth and respiratory symptoms due to chronic aspiration.
In 2009, a 48-year-old female schoolteacher from Suriname sought care at the Amsterdam Medical Center for recently increasing retrosternal pain.
If a foreign body is in the lower parts of the oesophagus, there can be various symptoms, among which are odynophagia, choking and retrosternal pain.
He reported "pressure-like" retrosternal pain, sudden in onset, 10/10 in intensity, radiating to the neck, and similar in character to the pain associated with his previous MI.
1,2) Usually they are asymptomatic; however, symptoms may include dysphagia, odynophagia, retrosternal pain, cricopharyngeal spasm, cough, and dyspnea.