PAINLESS MYOCARDIAL INFARCTION;

Abstract

Objective: To determine the frequency of painless MI in patients with acute coronary syndrome. Study design: Descriptivecross-sectional study. Setting and duration: This study was conducted at cardiology unit Nishtar Hospital Multan and Chaudhry PervezElahi Institute of Cardiology Multan. The study duration was 1 year starting from July 2011 to June 2012. Materials and Methods: Thisdescriptive study included 331 patients of AMI of either sex and age which were admitted at “Cardiology unit Nishtar Hospital Multan andChaudhry Pervez Elahi Institute of Cardiology Multan” using non-probability convenience sampling technique. Informed verbal consentwas taken from each patient for participation. Results: Out of these 331 patients 308 (93.1%) patients reported chest pain as thepresenting complaint. Remaining 23(6.9%) presented with clinical feature other than chest pain. Of these 23 patients who presentedwithout chest, minimum age was 30 years while maximum was 90 years with mean age 54.82 ± 12.28 years. Patients with painless AMIpresented with variety of symptoms. Most common symptoms seen in patients of AMI without chest pain were generalized weakness andcold sweats. Out of 23 patients with painless AMI, 15(65.22%) patients were male and 08(34.8%) were female. Diabetes mellitus waspresent as co-morbid condition in 16(69.56%) while 7(30.44%) patients were non diabetic. Hypertension was present in 8(34.78%)patients with painless AMI. Conclusions: Painless AMI or atypical presentation of AMI is seen in substantial proportion of ischemic heartdisease patients. Absence of chest pain in AMI patients may misguide the doctors and diverts his attention towards other diagnosis whichcan lead to considerable delay in the essential therapies required in the management of AMI. It definitely affects morbidity and mortality ofemergency department. Health care professionals particularly those working in emergency set up must keep in mind that absence ofchest pain in suspected cases of ischemic heart disease does not necessarily rule out AMI. Features of AMI other than chest pain shouldalso be kept in mind while dealing with a suspected case of ischemic heart disease. Further research work on painless AMI andpresentation of AMI other than chest pain is needed.