John G. Canto, MD, MSPH; Robert J. Goldberg, PhD; Mary M ...



Analysis of presenting complaint of Acute Coronary Syndrome patients in Teaching Hospital- PeradeniyaAbstractIntroduction Acute myocardial infarction is a medical emergency. Chest pain which was severe, persistent, radiation to left arm and associated with difficulty in breathing is considered as classic presentation of ischemic chest pain. Whereas vague symptoms which deviate a lot from typical explanation, can be a presentation of acute coronary syndrome which ends up in delayed diagnosis. To complicate the clinical picture other organs in chest can also give rise to pain, which may mimic ischaemic pain . Myocardial infarction was diagnosed beyond doubt using clinical presentation, biochemical, electrocardiographic and imaging all together. During emergency management, timely diagnosis of acute coronary syndrome depends on distinguishing differences between ischemic symptoms and non ischemic chest pains. This delay in identifying ischaemic chest pain by patient himself and the medical staff results in delay in proper management of this medical emergency, and subsequently leading to developing complications with poor prognosis of the patient. In this study atypical presentation of our general population was assessed with regard to site of pain and other associated symptoms with chest pain. It was also focused on how the age and sex differences affect the presenting symptoms of patients of our population. Material & MethodsA total of 101 patients admitted to ward7 and 8 of Teaching Hospital- Peradeniya (THP) from 2014 February, who were diagnosed and managed as Acute coronary syndrome during particular admission, irrespective of age and gender, interviewed by investigators for their major presenting complaint and other associated symptoms of the incident they have experienced. Informed consent was taken from patient to participate to study. Data was collected on prepared questionnaire as gained by direct questioning of patient, bystanders, investigation results and management carried out during admission. Data were analyzed using IBM- SPSS standard statistical software. Demographic difference of presenting symptoms also analysed.Results and discussionThe study group comprises of 101 patients. There only 7.9% had presented to medical care without chest pain whereas rest of patients had complained of chest pain.In chest pain group 46.5% had central chest pain and 28.7% had Left sided chest pain. Few patients had complained of atypical pains such as, right side chest pain 7.9% , diffuse 4%, retrosternal 3% and upper-abdominal 2% pain. Thus, although they were considered as atypical presentations it was possible to be the initial presentation of a Myocardial Infarction.28.7% of the study-group had complained of faintishness associated with the chest pain. Rest of patients, which includes majority of study group, had not felt faintishness following chest pain.Other significant symptoms patients complained except chest pain were also inquired. Common complaints were sweating (22%), SOB (22%) and nausea (10%). 33% had denied any significant symptom other than chest pain.Presenting complaint was analyzed with sex difference as to find out does the gender affects to the symptoms of Myocardial Infarction. As results revealed, both genders have complained of Central ( 27% Male and 20% Female) and Left side ( 14% Male and 15% Female) chest pain as major symptom. Thus, it was unlikely of a gender bias in presenting complaint of Myocardial infarction.When the site of chest pain was analyzed with the age categories, still the central ( Total 47%) and left side ( Total 29%) chest pains were the commonest complaint of each age group. ConclusionsWith considered to findings, typical presentation of MI is central or left side chest pain which is prolonged and severe in a middle aged patient. This presentation is highly suggesstive of cardiac origin ischaemic pain despite the gender or age category. But There is significant overlap in chest pain of cardiac in origin with non cardiac chest pain. atypical presentations without chest pain or significant vague symptoms presents to medical care which needs meticulous attention to prevent delay in diagnosis. Although chest pain is the most important symptom of Myocardial Infarction but it may be invariably absent in some patients. Thus first contact medical personnel should be aware of possibility of vague presentation of myocardial infarction to perform a vigilant history taking and emergency investigations. ReferencesJohn G. Canto, MD, MSPH; Robert J. Goldberg, PhD; Mary M. Hand, MSPH, RN; Robert O. Bonow, MD; George Sopko, MD, MPH; Carl J. Pepine, MD; Terry Long, BA (2007) Symptom Presentation of Women With Acute Coronary SyndromesMyth vs Reality JAMA Internal Medicine [Online] (167) p2405-2413 Available from: . article.aspx?articleid=770038 [accessed: 20 th January 2014]Cynthia Arslanian-Engoren, PhD , , Amisha Patel, BA, Jianming Fang, MD, David Armstrong, BA, Eva Kline-Rogers, MS, Claire S. Duvernoy, MD, Kim A. Eagle, MD (2006) Symptoms of Men and Women Presenting With Acute Coronary Syndromes The American Journal of Cardiology [Online] (98) p1177–1181 Available from: . science/article/pii/S0002914906013646 [accessed: 20 th January 2014]Goldberg, Robert J.; Goff, David; Cooper, Lawton ; Luepker, Russell ; Zapka, Jane ; Bittner, Vera ; Osganian, Stavroula ; Lessard, Darleen ; Cornell, Carol ; Meshack, Angela ; Mann, Clay ; Gilliland, Janice ; Feldman, Henry (2000) Age and sex differences in presentation of symptoms among patients with acute coronary disease: the REACT trial Coronary artery disease [Online] (11) p399-407 Available from: coronary-artery/Abstract/2000/07000/ Age_and_sex_differences_in_presentation_of.4.aspx [accessed: 20 th January 2014] ................
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