acute myocardial infarction

(redirected from Shoulder 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
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a·cute cor·o·nar·y syn·drome

(ACS) (ă-kyūt' kōr'ŏ-nar-ē sin'drōm)
A general term for clinical syndromes due to reduction of blood flow in coronary arteries (e.g., unstable angina, acute myocardial infarction).
Synonym(s): acute myocardial infarction, preinfarction angina, unstable angina.

a·cute cor·o·nar·y syn·drome

(ACS) (ă-kyūt' kōr'ŏ-nar-ē sin'drōm)
A general term for clinical syndromes due to reduction of blood flow in coronary arteries.
Synonym(s): preinfarction angina, unstable angina.
References in periodicals archive ?
Chronic shoulder pain in the community: a syndrome of disability or distress?.
There are various reasons why you might be experiencing shoulder pain, which commonly include: | |Frozen shoulder - a painful condition that limits normal movement and can sometimes stop you from moving your shoulder altogether.
Background: Studies reporting prevalence of shoulder pain in competitive archery are limited.
Suprascapular nerve entrapment is an uncommon but significant cause of shoulder pain [1], and a ganglion originating from the soft tissues around the spinoglenoid notch has been reported to be a cause of suprascapular nerve entrapment [2].
Sometimes the cause of shoulder pain is linked to other parts of the body such as neck problems, shingles, lung problems, gall stones, chest and heart pain or myofascial pain- a chronic condition that affects the connective tissue which cover the muscles.
High levels of the perceived work stress have been associated with an increased risk of neck/ shoulder pain in some studies [7,8], while others have found no such an association [9].
As well as the broken hand PC Sharpe also sustained damage to her ribs and back and shoulder pain.
Shoulder pain is one of the most common musculoskeletal problems in the community, (1) constituting 16% of all musculoskeletal system complaints.
Holly Springs, NC, May 06, 2016 --(PR.com)-- Back in Action Physical Therapy will offer several free classes on neck, back and shoulder pain beginning May 12th and running through August 11th at the Hunt Center in Holly Springs.
A 78-year-old woman sought care at our emergency department for sudden-onset right shoulder pain that had begun 5 days earlier.
Our objective was to find the frequency of neck and shoulder pain and use of adjustable computer workstation among bankers of Islamabad/Rawalpindi/Multan.