INCIDENCE OF ATYPICAL PRESENTATION OF MYOCARDIAL INFARCTION

Abstract

Context: Chest pain is widely considered a key symptom in the diagnosis of myocardial infarction, although
not all patients with MI present with chest pain.
Objectives: To determine the frequency with which MI patients present without chest pain and finding
elements in the history of atypically presesnting patients that may be helpful to the clinician in identifying
atypical MI.
Design: Descriptive type of study.
Place and Duration of Study: The study was conducted for the duration of 3.5 months (16-07-07 to 30-10-07)
in the CCU of a large Tertiary Care Hospital i.e. Holy Family Hospital of Rawalpindi District, attached with
Rawapindi Medical College.
Patients and Methods: We made a Performa and filled it by direct interview, reading the remarks of the
consultant about the patient written on the file, using the hospital lab results and by discussing the patient's
file remarks with the medical officer on duty. We included the patients of MI admitted in the CCU that
fulfilled our diagnostic criteria.
Results: Of all 125 patients diagnosed as having MI, 20.8% did not have chest pain on presentation to the
hospital. Atypical presentation of MI was mostly among elderly and diabetic patients. Maximum number of
MI patients presenting atypically were of age greater than 74 years (33.33%), with a higher proportion of
men (69.23% vs 30.77%). Associated symptoms were more manifested in atypically presenting MI patients.
Conclusions: Our results suggest that patients without chest pain represent a substantial segment of the MI
population. Patients with pain lasting for more than 1 hour, which is continuous, fullness sensation or
pressure sensation or constricting in character located in epigastric, interscapular region or in jaw and neck
should be 1st explored for an atypically presenting MI.