SYMPTOMS AND SIGNS

OF MYOCARDIAL
INFARCTION
DR. SWAPAN KUMAR DAS
SYMPTOMS
Pain
 Deep and visceral
 Heavy, squeezing, crushing
 Stabbing and burning
 Commonly occurs at rest
 More severe, lasts usually > 30 mins
 Typically involves central portion of chest and/or epigastrium
 On occasion radiates to arms
 Less common radiation- abdomen, back, lower jaw, neck
 May radiate as high as occipital area, but not below umbilicus
 Weakness, swearing, vomiting, anxiety, a sense of impending doom- usual
association
 If occurs during exertion, does not subside after cessation of activity
 Pain is not uniformly present in STEMI
 Elderly- May present with syncope, unexplained nausea, vomiting, acute
confusion, agitation or palpitation, sudden onset of breathlessness
 >75 years- may have atypical presentation, may lead to missed diagnosis
 20% acute MI patients are asymptomatic, or have atypical symptoms which
are not easily recognized.
PAINLESS MYOCARDIAL INFARCTION
 Occur frequently in elderly, women, diabetes, post operative patients.
 Presents with dyspnea or CHF.
LESS COMMON PRESENTATION WITH OR WITHOUT PAIN
 Sudden loss of consciousness
 Confused state
 Sensation of profound weakness
 Arrythmia
 Evidence of peripheral embolism
 Unexplained drop in arterial pressure
• NSTEMI
CHEST DISCOMFORT OR PAIN
 Severe
 At least one of three features-
 Rest with minimal exertion> 10 min
 Relatively recent onset (within 2 weeks)
 Crescendo Pattern
 Substernal region
 Radiates to left arm, left shoulder and/or superiorly to neck, jaw
SIGNS

 Most patients- anxious, restless

 Pallor, perspiration, cold extremities- common
 Anterior infarction-
 Tachycardia and hypertension (SNS increased activity)
 Abnormal systolic pulsation due to dyskinetic bulging in the periapical area
 Inferior Infarction- Bradycardia and/or hypertension (parasympathetic
hyperactivity)
 Pericardium- quiet, apical impulse difficult to palpate
 Appearance of 3rd and 4th heart sound (ventricular dysfuntion)
 Decreased intensity of s1
 Transient midsystolic or late systolic apical systolic murmur (mitral valve
apparatus dysfuntion)
 A pericardial friction rub
 Carotid pulse- decreased volume, due to reduced stroke volume
 Temperature elevation upto 38°C during first week after STEMI
RVMI
 Increased jugular venous pressure
 Kussmaul sign
 RV- S3