Chest pain in the early recognition of large infarcts.

Among 90 patients admitted to hospital with a diagnosis of first myocardial infarction consistent significant associations were found between pain duration, increase in concentration of serum glutamic oxaloacetic transminase (SGOT), maximum temperature and type of infarct (transmural or nontransmural). This suggests that infarct size may be associated with pain duration, increase in SGOT concentration and maximum temperature, and that patients with transmural infarcts have larger infarcts than those with nontransmural infarcts. A higher incidence of premonitory pain -- in particular, premonitory rest pain -- was noted in patients with transmural infarcts, who also had a significantly higher leukocyte count than patients with nontransmural infarcts. Pain intensity was also found to be associated directly with increase in SGOT concentration. However, because intergroup differences were not significant consistently, the association between infarct size, premonitory pain, pain intensity and leukocytosis is less certain. If the association between pain duration and infarct size is confirmed, a simple means would be available for the early recognition of the patient with a large infarct and adverse prognosis who would benefit from prompt therapeutic measures to reduce infarct size.