The painless form of acute myocardial infarction

Czech version

Authors: S. Janoušek
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno pracoviště Bohunice
Published in: Kardiol Rev Int Med 2007, 9(4): 222-228
Category: Editorial

Overview

The results of studies and data from registries show that prevalence of acute myocardial infarction (AMI) without chest pain is relatively high. The main important subgroups with high rate of painless AMI groups are older patients, women, diabetics and hypertonics. The main presenting symptoms included dyspnoea (or heart failure), nausea and vomitus (or other gastrointestinal complaints), diaphoresis, palpitation, syncopes, arrhythmias up to cardiac arrest, sudden malaise or weakness, strokes, and in the elderly also confusion or sudden worsening of cognitive functions. The observation show that is very threatened group of patients what is consequence of many adverse factors. Their arrival in hospital in mean is delayed with comparison of patients with typical symptoms and in addition more than 20% was not admitted under diagnosis of AMI. That is in connection with fact, that ECG pattern of ST elevation (STEMI) is there less frequent. the establishing of diagnosis is delayed. Moreover in patients with correct diagnosis of AMI the establishing of diagnosis is delayed. That all is reason for less frequent acute reperfusion therapy that is often also significantly delayed. Also their entry, consecutive and discharge pharmacotherapy is suboptimal in comparison with actual guidelines of AMI treatment. They also less frequent undergo coronarography, less commonly included into cardiac rehabilitation program or followed by cardiologists. The result of that all is unfavorable hospitalization prognosis with high rate of heavy complications and significantly higher short- and long-time mortality. It is difficult to find the way to improve prognosis of that group. Besides educational program about alternative of atypical AMI presentation not only for patients but mostly for medical staff the possibility of early ECG record and troponin analysis also in cases without chest pain is suggesting. Definitely the emphasis on invasive diagnostics and aggressive pharmacotherapy is necessary in these patients.

Key words:
acute myocardial infarction, painless form, atypical symptoms, prevalence, risk groups, treatment, complications, prognosis

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