Symptoms associated with myocardial infarction: are they of diagnostic value?

Symptoms experienced by 227 consecutive patients before their admission to the coronary care unit were identified by questionnaire and those associated with myocardial infarction (98) compared with those occurring with ischaemia (53) and chest pain or discomfort of unknown cause (29). The diagnosis of myocardial infarction by the nature of the resultant pain or discomfort was unreliable in contrast to the associated symptoms sweating, nausea, belching and vomiting. The predictive value of the latter was 91%. Nausea was associated with inferior site of infarction and development of Q waves on the electrocardiogram. Morphine administration was not followed by an increased incidence of vomiting. Back pain or discomfort during infarction was experienced twice as often by women.