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
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References in periodicals archive ?
It is characterized by severe and persistent retrosternal pain, increased serum myocardial enzymes activity and progressive electrocardiographic changes.
The degree of symptoms, including weight loss, dysphagia, retrosternal pain, and regurgitation, was graded pre- and postoperatively using the Eckardt score.
Although the complaints of patients vary in cases of oesophageal foreign bodies, the most common symptoms are dysphagia and vomiting,4 the accumulation of saliva in the mouth, and retrosternal pain, occasionally associated with myocardial infarction, may also occur.
Seven patients complained of retrosternal pain. Eight (17%) patients had hyperthyroidism and were treated with antithyroid agents preoperatively.
Symptom score was graded according to the Eckardt score [18] for weight loss (0 = none, 1 = <5 kg, 2 = 5-10 kg, and 3= > 10 kg), dysphagia (0 = none, 1 = occasional, 2 = daily, and 3 = each meal), retrosternal pain (0 = none, 1 = occasional, 2 = daily, and 3 = each meal), and regurgitation (0 = none, 1 = occasional, 2 = daily, and 3 = each meal), and the dysphagia score [19] (0 = no dysphagia, 1 = able to eat some solid foods, 2 = able to eat semisolid foods, 3 = able to swallow liquids only, and 4 = unable to swallow anything).
When clinically recognizable, the symptomatology of AP mainly includes central and pleuritic chest pain and sharp retrosternal pain with common characteristics such as irradiation to one or both trapezius ridges, neck, jaw, or arms imitating myocardial ischemia with various degrees of severity [1, 5].
(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.
It normally presents with pressure symptoms like respiratory distress due to pressure on the bronchi or lung, cough, cyanosis, retrosternal pain, and dysphagia.
55 (63.2%), 30 (34.5%) and 21 (24.1%) 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 13.600/[mm.sup.3], 77 percent neutrophils).
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.