Clinical features

The clinical features of acute myocardial infarction include: (1,2)

• chest pain:
  • central, crushing pain
  • may radiate to the jaw, neck, and one or both arms
  • is a similar pain to that found in angina pectoris but patients with previous angina will often complain that the pain is more severe and lasts longer than angina
• nausea, vomiting, sweating
• the patient is often distressed and may be tachycardic, cold and clammy
• blood pressure is variable
• the patient may be cyanosed
• mild pyrexia is variable feature

Presentation may be with features of the complications, such as left ventricular failure - e.g. with dyspnoea.

Myocardial infarction is silent in 30% - particularly in people with diabetes and elderly patients.

References:

1. Byrne RA, Rossello X, Coughlan JJ, et al; ESC Scientific Document Group. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-826.
2. National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. November 2016 [internet publication].