cardiovascular disorders
Acute Myocardial Infarction (MI)
Symptoms and Signs of Acute MI
Symptoms of NSTEMI and STEMI are the same. Days to weeks before the event, about two thirds of patients experience prodromal symptoms, including Unstable Angina , shortness of breath, and fatigue. Usually, the first symptom of infarction is deep, substernal, visceral pain, described as aching or pressure, often radiating to the back, jaw, left arm, right arm, shoulders, or all of these areas. The pain is similar to Symptoms and Signs but is usually more severe and long-lasting; more often accompanied by dyspnea, diaphoresis, nausea, and/or vomiting; and relieved little or only temporarily by rest or Some patients present with syncope. Women are more likely to present with atypical chest discomfort. Older patients may report dyspnea more than ischemic-type chest pain. In severe ischemic episodes, the patient often has significant pain and feels restless and apprehensive. Nausea and vomiting may occur, especially with inferior MI. Dyspnea and weakness due to LV failure, pulmonary edema, shock, or significant arrhythmia may dominate. Skin may be pale, cool, and diaphoretic. Peripheral or central cyanosis may be present. Pulse may be thready, and blood pressure is variable, although many patients initially have some degree of hypertension during pain. Heart sounds are usually somewhat distant; a 4th heart sound is almost universally present. A soft systolic blowing apical murmur (reflecting papillary muscle dysfunction) may occur. During initial examination, a friction rub or more striking murmurs suggest a preexisting heart disorder or another diagnosis. Detection of a friction rub within a few hours after onset of MI symptoms suggests acute Pericarditis rather than MI. However, friction rubs, usually evanescent, are common on days 2 and 3 post-STEMI. The chest wall is tender when palpated in about 15% of patients. In right ventricular (RV) infarction, signs include elevated RV filling pressure, distended jugular veins (often with Neck veins ), clear lung fields, and hypotension. 