Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms?

Abstract

Studies indicate that symptoms labeled as “atypical” are more common in women evaluated for myocardial infarction (MI) and may contribute to the lower likelihood of a diagnosis and delayed treatment and result in poorer outcomes compared with men with MI. Atypical pain is frequently defined as epigastric or back pain or pain that is described as burning, stabbing, or characteristic of indigestion. Typical symptoms usually include chest, arm, or jaw pain described as dull, heavy, tight, or crushing. In a recent article published in the Journal of the American Heart Association ( JAHA ), Ferry and colleagues addressed presenting symptoms in men and women diagnosed with MI and reported that typical symptoms in women were more predictive of a diagnosis of MI than for men. A critical question is, are there really typical or atypical symptoms, and if so, who is the reference group? We propose that researchers and clinicians either discontinue using the terms typical and atypical or provide the reference group to which the terms apply (eg, men versus women). We believe it is past time to standardize the symptom assessment for MI so that proper and rapid diagnostic testing can be undertaken; however, we cannot standardize the symptom experience. When we do this, we are at risk of having study results, such as those of Ferry and colleagues, that vary from prior evidence and could lead to what the authors hope to avoid: disadvantaging women in receiving expeditious diagnostic testing and treatment for acute coronary syndrome.

Population-Based Multilevel Models to Estimate the Management Strategies for Acute Myocardial Infarction in Older Adults with Dementia

“…It is likely that AMI cases were under-diagnosed in older adults with dementia due to the atypical presentation AMI syndrome. 33 , 34 There are also communication difficulties for patients with dementia to accurately describe their symptoms. The estimation of number of AMI cases among dementia patients is not, however, the main objective of the study as we were more interested in finding out the influence of management strategies for these older adults that could be potentially useful in improving of quality of life.…”

Nebyliojo Miokardo Infarkto Apibrėžimas, Rizikos Veiksniai Ir Ryšys Su Staigia Mirtimi

“…Literatūroje pateikiama netipiško MI skausmo definicija nėra pakankamai tiksli. Kai kurie autoriai necharakteringiems MI požymiams priskiria šiuos simptomus: 1) mažesnio intensyvumo tipinius krūtinės anginos skausmus − diskomfortą krūtinės, rankos, apatinio žandikaulio srityse [8]; 2) klinikinius simptomus, pasireiškiančius neįprastinėse MI vietose − skausmą nugaros ar epigastriumo srityje, panašų į nevirškinimo jausmą arba apibūdinamą kaip duriantį ar deginantį [9]; kaip nespecifiški simptomai įvardinami ir su krūtinės skausmu nesusiję požymiai, tokie kaip tachikardija, palpitacijos, diaforezė, ryškus nuovargis ar dusulys [5][6][7]10]. Kaip jau aptarta, nors didžioji dalis NMI atvejų nėra mirtini, simptomų išraiškingumas ne visada koreliuoja su pažeidimo plotu, todėl skubiosios pagalbos skyriuose ypač aukštos rizikos pacientams, atvykusiems su netipiniais simptomais, kliniškai visada turėtų būti įtariama MI diagnozė.…”

Síndrome coronario agudo atípico, un reto diagnóstico: revisión de tema

“…No hay datos suficientes para hablar de una presentación atípica en mujeres, puesto que esto implica tener una sintomatología estándar y hay pocos síntomas sensibles o específicos para el diagnóstico del SCA. De hacer referencia entonces a una presentación atípica debería proveerse el grupo de referencia al que aplican los términos (por ejemplo, hombres versus mujeres), pues se han encontrado síntomas con mayor sensibilidad en las mujeres, como: indigestión (30% versus 18%), disnea (58% versus 41%), palpitaciones (27% versus 17%) y dolor del dorso superior (34% versus 14%) 21 .…”