Clinical Manifestations

The onset of symptoms in myocardial infarction

(MI) is usually sudden onset last longer than 15
minutes.The quantity is severe and sometimes
mild " in 30% of clients". Chest pain is the most
common symptom of acute MI and is often
described as a sensation of tightness, pressure,
superficial, knifelike and burning contraction .
Chest pain due to ischemia (a lack of blood and
oxygen supply of the heart muscle). Pain radiates
most often to the left arm, but may also radiate to
the lower jaw, neck, right arm, back, and upper
abdomen, where it may be heartburn. Shortness of
breath (dyspnea) occurs when the damage to the
heart limits the output of the left ventricle,
causing left ventricular failure and
consequent pulmonary edema. Other symptoms
include diaphoresis (an excessive form
of sweating),weakness, lightheadedness, nausea,v
omting, and palpitations. These symptoms are
likely induced from the sympathetic nervous
system, which occurs in response to pain and the
blood flow abnormalities that result from
dysfunction of the heart muscle. Loss of
consciousness (due to inadequate blood flow to the
brain and cardiogenic shock) and sudden
death (frequently due to the development
of ventricular fibrillation)

Be alert for the following signs and symptoms:

Cardiovascular

 Chest pain or discomfort not relieved by rest or

nitroglycerin palpitations. Heart sounds may
include S3, S4, and new onset of a murmur.
Increased jugular venous distention may be seen
if the MI has caused heart failure.
Blood pressure may be elevated because of
sympathetic stimulation or decreased because of
decreased contractility, impending cardiogenic
shock, or medications.
Irregular pulse may indicate atrial fibrillation.
In addition to ST-segment and T-wave changes,
ECG may show tachycardia, bradycardia, or other
dysrhythmias.
Respiratory
Shortness of breath, dyspnea, tachypnea, and
crackles if MI has caused pulmonary congestion.
Pulmonary edema may be present
Gastrointestinal
Nausea and vomiting.
Genitourinary
Decreased urinary output may indicate cardiogenic
shock.
Skin
Cool, clammy, diaphoretic, and pale appearance
due to sympathetic stimulation may indicate
cardiogenic shock.
Neurologic

Anxiety, restlessness, and lightheadedness may

indicate
increased sympathetic stimulation or a decrease in
contractility and cerebral oxygenation.The same
symptoms
Psychological
Fear with feeling of impending death, or denial that
anything is wrong