Just abdominal pain? Don't rule out cardiac

If your patient complains of abdominal pain, a heart attack might not be the first thing you think of. However, this diagnosis is certainly one possibility, says Cathy C. Fox, RN, CEN, CPEN, clinical nurse educator for the ED at Sentara Virginia Beach (VA) General Hospital.

Fox once cared for an 83-year-old female who rated her abdominal pain as a 10 on a scale of 1 to 10. She was doubled over in pain, diaphoretic, and had been vomiting prior to arrival. She had hypertension and elevated pulse and respiratory rates. "Her only other subjective complaint was no bowel movement for three days, and she normally was very regular," says Fox.

An electrocardiogram (EKG) revealed that the woman was having an anterior wall myocardial infarction (MI) with ST elevation in leads V3 and V4. "She was clinically constipated on exam, but the extreme pain and discomfort may have led to increased stress on the heart," says Fox.

Tracy Simmons, RN, clinical educator for the ED at OSF St. Francis Medical Center in Peoria, IL, cared for a woman whose only complaint was intermittent abdominal pain for two days. "Her pain did not sound cardiac in nature. But because she was a woman, we did a cardiac workup and ran the labs just to be safe," she says.

The woman's pain was not relieved with nitroglycerin, but it subsided after a gastrointestinal cocktail was administered. Although she had no significant EKG changes, cardiac enzymes were elevated. "She had been having an MI for a couple of days, but because of her presentation, she did not appear to be that typical cardiac patient," says Simmons. "After calling cardiology for a consult, she went to the cath lab and had a couple of stents placed for her blocked arteries."

Sources

For more information on assessment of abdominal pain, contact:

  • Cathy C. Fox, RN, CEN, CPEN, Emergency Department, Sentara Virginia Beach (VA) General Hospital. Phone: (757) 395-8954. E-mail: ccfox@sentara.com.
  • Tracy Simmons, RN, BSN, CEN, Clinical Educator, Emergency Department, OSF St. Francis Medical Center, Peoria, IL. Phone: (309) 655-4103. E-mail: tracy.a.simmons@osfhealthcare.org.

Clinical Tip

Does patient appear anxious? Suspect MI

Tracy Simmons, RN, clinical educator for the ED at OSF St Francis Medical Center in Peoria, IL, says although it can happen, in her experience, myocardial infarction (MI) patients don't typically present with severe pain.

"Usually, pain of an MI is more subtle," Simmons says. "I get more nervous when a patient is very quiet and anxious-looking and says they just don't feel well, than if they are screaming their head off that they have chest pain."