Myocardial Infarction
A Myocardial Infarction results in myocardial tissue death and occurs when the coronary arteries do not provide sufficient blood flow to the myocardial tissue. Ischemic conditions can be caused by atherosclerotic plaque, thrombosis formation (blood clot), embolism, or vasospasm of the coronary arteries
Demographics:
- In the U.S. alone, someone suffers from a heart attack every 34 seconds.
Major, non-modifiable risk factors: Male, >65 years old, race (African American/Mexican American/ American Indians/ Native Hawaiians/Asian Americans), and family history of heart disease.
Note: Women who suffer heart attacks are much more likely to die within a few weeks than their male counterparts
Modifiable risk factors: Hypercholesterolemia, Hypertension, physical inactivity, obesity/overweight, diabetes mellitus, stress, alcohol intake, diet and nutrition
Clinical Presentation: The clinical presentation of heart attack has the potential to vary widely between patients and differs distinctly between genders. Scroll down to see a chart of heart attack pain referral for men and women.
Other Signs and Symptoms include:
Differential Diagnosis: Differentiating MI from musculoskeletal or other origin can be done by recognizing patterns of aggravating and easing factors.
Angina:
1) Begins 3-5 minutes after exertion or activity (lagtime); moderate intensity, chest discomfort/tightness
2) Can occur at rest or during sleep
3) Usually occurs with exertion, emotion, cold or large meals; subsides with rest or nitroglycerin; worse when lying down
4) Pain related to tone of arteries (spasm)
MI
1) 30 minutes-1 hour
2) Severe (can be painless); Crushing pain/intolerable (can be painless); exertion
3) Unrelieved by rest or nitroglycerin
4) Pain related to heart ischemia
NOTE: Women are more likely to experience atypical symptoms such as vague chest discomfort, nausea, neck pain, dyspnea, indigestion and/or fatigue
Pericarditis
1) Hours to days
2) Mild to severe, asymptomatic, sharp or cutting ,can mimic MI
3) Worse with breathing, swallowing, belching, neck or trunk movement
4) Relieved by kneeling on all fours, leaning forward, sitting upright, or breathholding; pain related to inflammatory process
Other common causes of chest pain:
Bottom Line: Refer
Patients presenting with Thoracic region pain (or any other referral region as seen in the “referred pain” charts) that is exacerbated by exertion and unrelieved by rest or nitroglycerin should be referred out immediately. All of the above non-modifiable and modifiable risk factors should be taken into consideration but in isolation are not sufficient for an immediate referral (AHA 2011).
References:Please refer to the "Myocardial Infarction" section of the reference list.
Demographics:
- In the U.S. alone, someone suffers from a heart attack every 34 seconds.
Major, non-modifiable risk factors: Male, >65 years old, race (African American/Mexican American/ American Indians/ Native Hawaiians/Asian Americans), and family history of heart disease.
Note: Women who suffer heart attacks are much more likely to die within a few weeks than their male counterparts
Modifiable risk factors: Hypercholesterolemia, Hypertension, physical inactivity, obesity/overweight, diabetes mellitus, stress, alcohol intake, diet and nutrition
Clinical Presentation: The clinical presentation of heart attack has the potential to vary widely between patients and differs distinctly between genders. Scroll down to see a chart of heart attack pain referral for men and women.
Other Signs and Symptoms include:
- Dyspnea
- Nausea
- Vomiting
- Diaphoresis
- Lightheadeness
Differential Diagnosis: Differentiating MI from musculoskeletal or other origin can be done by recognizing patterns of aggravating and easing factors.
Angina:
1) Begins 3-5 minutes after exertion or activity (lagtime); moderate intensity, chest discomfort/tightness
2) Can occur at rest or during sleep
3) Usually occurs with exertion, emotion, cold or large meals; subsides with rest or nitroglycerin; worse when lying down
4) Pain related to tone of arteries (spasm)
MI
1) 30 minutes-1 hour
2) Severe (can be painless); Crushing pain/intolerable (can be painless); exertion
3) Unrelieved by rest or nitroglycerin
4) Pain related to heart ischemia
NOTE: Women are more likely to experience atypical symptoms such as vague chest discomfort, nausea, neck pain, dyspnea, indigestion and/or fatigue
Pericarditis
1) Hours to days
2) Mild to severe, asymptomatic, sharp or cutting ,can mimic MI
3) Worse with breathing, swallowing, belching, neck or trunk movement
4) Relieved by kneeling on all fours, leaning forward, sitting upright, or breathholding; pain related to inflammatory process
Other common causes of chest pain:
- Heartburn
- Ulcer
- Pleurisy
- Costochondritis
Bottom Line: Refer
Patients presenting with Thoracic region pain (or any other referral region as seen in the “referred pain” charts) that is exacerbated by exertion and unrelieved by rest or nitroglycerin should be referred out immediately. All of the above non-modifiable and modifiable risk factors should be taken into consideration but in isolation are not sufficient for an immediate referral (AHA 2011).
References:Please refer to the "Myocardial Infarction" section of the reference list.