Abstract
Background: Cardiac pain arising from acute coronary syndrome (ACS) is a multi-factorial phenomenon. Historically, episodes of cardiac pain have been captured using a one-dimensional numeric pain rating scale. Lacking in clinical practice are acute pain assessments that employ a comprehensive evaluation of an emergent ACS episode. Aim: To examine the sensory-discriminative, motivational-affective and cognitive-evaluative dimensions of ACS-related pain. Methods: A descriptive-correlational, repeated-measure design was used to collect data on 121 ACS patients of their cardiac pain intensity. The (numeric rating scale-NRS 0-10 scale) measured chest pain “Now” and “Worst pain in the previous 2 hours over 8 hours” and the McGill Pain Questionnaire Short-Form (MPQ-SF) measured pain at 4 hours. Results: Mean age was 67.6 ± 13, 50% were male, 60% had unstable angina and 40% had Non-ST-elevation myocardial infarction. Cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. MPQ-SF: 66% described pain as distressing and 26% reported pain was horrible or excruciating. Participants described ACS pain quality as acute injury (nociceptive pain: heavy, cramping, stabbing), as nerve damage (neuropathic: gnawing, hot-burning, shooting) and as a mixture of acute and chronic pain qualities (aching, tender and throbbing). Conclusions: Patients reported both nociceptive and neuropathic cardiac pain. It is unclear if pain perceptions are due to: i) pathophysiology of clot formation, ii) occurrence of a first or repeated ACS episode, or iii) complex co-morbidities. Pain arising from ACS requires an understanding of the interplay of ischemic, metabolic and neuropathophysiological mechanisms that contribute to complex cardiac pain experiences.
Highlights
IntroductionComplex cardiac pain presentations are problematic for patients to recognise and for clinicians to differentially diagnose as an acute coronary syndrome (ACS)
Lacking in clinical practice are acute pain assessments that employ a comprehensive evaluation of an emergent acute coronary syndrome (ACS) episode
Complex cardiac pain presentations are problematic for patients to recognise and for clinicians to differentially diagnose as an acute coronary syndrome (ACS)
Summary
Complex cardiac pain presentations are problematic for patients to recognise and for clinicians to differentially diagnose as an acute coronary syndrome (ACS). Cardiac-related pain arising from narrowed or blocked heart arteries (coronary artery disease [CAD]), resulting in myocardial ischemia, is individual and varies within a spectrum of unique symptom presentations. The individual experience of cardiac pain is complicated and relates to the cumulative effect of myocardial oxygen supply and demand imbalance, the pain mechanisms involved in the neuro-modulation of painful stimuli at the levels of the neuroaxis, peripheral nerves, spinal cord and brain [7] and changes in neuro-plasticity that occur at the peripheral and central levels resulting in central sensitization [4] [5] [6] [10]. Conclusions: Patients reported both nociceptive and neuropathic cardiac pain It is unclear if pain perceptions are due to: i) pathophysiology of clot formation, ii) occurrence of a first or repeated ACS episode, or iii) complex co-morbidities. Pain arising from ACS requires an understanding of the interplay of ischemic, metabolic and
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