Journal Review

Gupta M, Tabas JA, Kohn MA. Presenting complaint among patients with myocardial infarction who present to an urban, public hospital emergency department. Ann Emerg Med 2002; 40:180-186.

This study reports that almost 50% of patients with acute myocardial infarction (AMI) present to the emergency department (ED) without a chief complaint of chest pain. Researchers from the University of California, Berkeley; University of California, San Francisco; and San Francisco General Hospital did a retrospective review of ED patients who were diagnosed with an AMI over a five-year period. Here are key findings:

  • Of 721 patients with diagnosed AMI, 53% presented with chest pain.
  • Other complaints were shortness of breath (17%); cardiac arrest (7%); dizziness/weakness/syncope (4%); abdominal pain (2%); and other (17%).
  • Older patients and women were more likely to present without chest pain.
  • Patients older than 84 years old were at highest risk to present without chest pain.

"This report sheds important light on our understanding of the spectrum and frequencies of complaints other than chest pain in patients with AMI," the researchers conclude. They note the following implications:

  • Having a heightened awareness of atypical presentations may prevent the mistaken discharge of AMI patients.
  • Patients who present without chest pain have significantly longer door-to-treatment times for thrombolytic agents and primary angioplasty, so an awareness of atypical presentations could result in quicker treatment.

Atypical symptoms should be included in triage criteria to decrease time to thrombolysis for AMI patients.