Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

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Question 1 of 39:

The most likely cause of this patient's symptoms is an acute myocardial infarction.

You clicked 'True'

Correct!

When patients complain of central chest pain they must be quickly put into one of three categories:

• Acute chest pain of recent onset, which may be ongoing and persistent, (e.g. acute myocardial infarction, acute pulmonary embolism, acute aortic dissection, pneumothorax)
• Episodic, recurrent chest pain, with each individual episode lasting for minutes rather than hours, (e.g., stable angina pectoris)
• Persistent pain which may continue for hours or even days with variable fluctuation in intensity (e.g. musculoskeletal chest pain).

The pain of acute MI is usually described as tightness, pressure or squeezing discomfort in the lower retrosternal region. The pain may radiate to the left shoulder, neck or arm, jaw, teeth, back or abdomen. When the pain radiates from the chest to the left shoulder, neck or left arm, the likelihood that it represents acute MI is about three fold higher than when chest pain does not radiate to these locations. Often the patient describes the pain by illustrating a clenched fist- Levine's sign†. Diaphoresis may accompany any discomfort that evokes severe sympathetic stimulation or parasympathetic response.

Certain subgroups of patients are known to present with unusual symptoms of acute myocardial infarction. Women often experience atypical ischemic-type chest discomfort while elderly may complain of shortness of breath more frequently than ischemic-type chest discomfort.

†Samuel A Levine, MD was Professor of Cardiology at Harvard Medical School and attending physician at Peter Bent Brigham Hospital.