胸痛是急性心肌梗死（AMI）患者的主要主诉。
Chest Pain as a presenting complaint in patients with acute myocardial infarction (AMI).
机构信息
Dr. Muhammad Ajmal Malik, MBBS, MD, Senior Registrar, Nishtar Hospital Multan, Pakistan.
Dr. Shahzad Alam Khan, FCPS, Senior Registrar, Nishtar Hospital Multan, Pakistan.
出版信息
Pak J Med Sci. 2013 Apr;29(2):565-8. doi: 10.12669/pjms.292.2921.
OBJECTIVE
To study various characteristics of chest pain in acute myocardial infarction patients.
METHODOLOGY
A total of 331 patients of AMI admitted at Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan, irrespective of the age and gender, were included in this study. The study duration was one year starting from June 2011 to June 2012. Non-probability purposive sampling technique was used in this descriptive study. Informed consent to participate in this study was taken. Data were entered and analyzed using SPSS-11.
RESULTS
A total number of 331 patients with AMI were included in the study. Mean age was 54.99±11.25 years with minimum age 20 years and maximum age 90 years. It included 264(79.8%) male and 67(20.2%) female patients with male to female ratio of 3.9:1. Out of these 331 patients 308 (93.1%) patients reported chest pain as the presenting complaint. Remaining 23(6.9%) presented with clinical features other than chest pain. There were 127(38.4%) patients with pre-cordial chest pain, 115(34.7%) had retrosternal chest pain, 58(17.5%) were having epigastric pain. Severe chest pain was seen in 281(84.9%) patients while 26(7.9%) had only mild chest discomfort. Radiation of the pain to shoulder, neck and jaw was seen in 75 (22.7%) patients. In 42(12.7%) patients, pain radiated to both sides of chest. Another 55(16.6%) patients had pain radiation to chest, shoulder, upper arm and ulnar side of left forearm. Chest pain radiation to interscapular region along with both sides of chest was present in 10(3.0%) patients. In 11(3.3%) patients' pain radiated only to left side of chest. Pain persisting for >20 minutes was reported by 298 (90%) patients while only 10(3.1%) had pain persisting for <20 minutes.
CONCLUSION
There is considerable overlap in chest pain of cardiac as well as non cardiac causes. However, vigilant evaluation of characteristics of chest pain in history taking may help to overcome this dilemma. Severe and prolonged precordial chest pain in a male patient between the age of 41-70 years, with pain radiation to left shoulder, neck and jaw is highly suggestive of AMI.
目的
研究急性心肌梗死患者胸痛的各种特征。
方法
本研究纳入了 2011 年 6 月至 2012 年 6 月期间在旁遮普省纳希特医院和恰德尔·佩尔韦兹·埃拉希心脏病学研究所心内科就诊的 331 例 AMI 患者，无论年龄和性别。本研究采用描述性研究中的非概率目的抽样技术。本研究获得了患者的知情同意。使用 SPSS-11 输入和分析数据。
结果
本研究共纳入 331 例 AMI 患者。平均年龄为 54.99±11.25 岁，最小年龄 20 岁，最大年龄 90 岁。其中 264（79.8%）例为男性，67（20.2%）例为女性，男女比例为 3.9:1。这些患者中，308 例（93.1%）以胸痛为首发症状。其余 23 例（6.9%）表现为胸痛以外的临床特征。127 例（38.4%）患者有前胸部胸痛，115 例（34.7%）有胸骨后胸痛，58 例（17.5%）有上腹痛。281 例（84.9%）患者胸痛剧烈，26 例（7.9%）仅有轻度胸痛不适。75 例（22.7%）患者疼痛放射至肩部、颈部和颌部。42 例（12.7%）患者双侧胸痛放射，另 55 例（16.6%）患者胸痛放射至胸部、肩部、上臂和左侧前臂尺侧。10 例（3.0%）患者肩胛间区和双侧胸痛放射。11 例（3.3%）患者仅左侧胸痛放射。298 例（90%）患者胸痛持续>20 分钟，10 例（3.1%）患者胸痛持续<20 分钟。
结论
心脏病和非心脏病原因引起的胸痛有相当大的重叠。然而，在询问病史时仔细评估胸痛的特征可能有助于解决这一难题。41-70 岁男性患者剧烈、持续的前胸部胸痛，疼痛放射至左肩部、颈部和颌部，高度提示为 AMI。
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