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Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen. [28] [29] The pain most suggestive of an acute MI, with the highest likelihood ratio, is pain radiating to the right arm and shoulder. [30] [29] Similarly, chest pain similar to a previous heart attack is also suggestive. [31]
The ECG should be done as early as practicable, including in the ambulance if possible. [18] ECG changes indicating acute heart damage include: ST elevation, new left bundle branch block and ST depression amongst others. The absence of ECG changes does not immediately distinguish between unstable angina and NSTEMI. [6]
The 2018 European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Health Federation Universal Definition of Myocardial Infarction for the ECG diagnosis of the ST segment elevation type of acute myocardial infarction require new ST elevation at J point of at least 1mm (0.1 mV) in two contiguous leads with the cut-points: ≥1 mm in all leads ...
Chest pain due to coronary ischemia commonly radiates to the arm or neck. [7] Certain individuals such as women, diabetics, and the elderly may present with more varied symptoms. [ 8 ] If blood flow through the coronary arteries is stopped completely, cardiac muscle cells may die, known as a myocardial infarction, or heart attack.
Also, it can be a normal variant or artifacts, such as: Pseudo-ST-depression, which is a wandering baseline due to poor skin contact of the electrode [3] Physiologic J-junctional depression with sinus tachycardia [3] Hyperventilation [3] Horizontal ST depression in V4, V5, V6 leads during a cardiac stress ECG. Other, non-ischemic, causes include:
An anginal equivalent is a symptom such as shortness of breath , diaphoresis (sweating), extreme fatigue, or pain at a site other than the chest, occurring in a patient at high cardiac risk. Anginal equivalents are considered to be symptoms of myocardial ischemia .
Electrocardiogram (ECG or EKG): An ECG OR EKG monitors the wave representing the activity of the heart. [66] Any discrepancies or changes in the typical patterns indicate a cardiac condition, such as CVD, affecting the individual. Echocardiogram An echo provides an outline of the heart's function to help assess how well it is operating. [67]
Where the pain is on the body and whether it radiates (extends) or moves to any other area. This can give indications for conditions such as a myocardial infarction, which can radiate through the jaw and arms. Other referred pains can provide clues to underlying medical causes. Severity The pain score (usually on a scale of 0 to 10).