epigastric pain


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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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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 ?
Mixed symptoms were the main symptom subtype (75%), followed by post-prandial fullness (13.9%) and epigastric pain (11%).
Fasting and postprandial gastric sensorimotor activity in functional dyspepsia: postprandial distress vs epigastric pain syndrome.
It is possible that, in the future, MMPs to be used as a marker to help differentiate between the two causes of severe epigastric pain. Although more research into optimal markers and imaging needs to be done, the burden rests on the clinician's shoulders to keep a wide differential diagnosis.
A 58-year-old man presented with 1 month of epigastric pain after eating, which worsened when lying flat.
These patients usually have more severe systemic symptoms such as fever, weight loss, epigastric pain, neuropsychiatrie symptoms, or bone pain.
Epigastric pain syndrome (EPS) was present in 28.9% of the patients, postprandial distress syndrome (PDS) was present in 28.5% of the patients and 42.7% had both the symptoms.
Functional dyspepsia is defined by the presence of postprandial fullness, early satiety, epigastric pain or burning, and no evidence of structural disease.
Pancreatitis is usually seen as an excruciating epigastric pain with referred pain to the back.
Specific entries are devoted to abdominal pain in pregnancy, BellAEs palsy in pregnancy, abnormal cervical cytology, epigastric pain, postoperative fever, and a wide variety of other related subjects.
Patient 1 had mild abdominal and epigastric pain radiating to her back; onset of abdominal pain and flushing during meals; rigors most prominent at night; severe and voluminous diarrhea intensifying after meals; poor appetite; and urticaria associated with itching on her back, chest, and neck.
* Biliary colic is associated with right upper quadrant or epigastric pain that begins postprandially.