PAINLESS MYOCARDIAL INFARCTION;

Its frequency in patients of acute coronary syndrome.

Abstract

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