A study of clinical presentation and delays in management of acute myocardial infarction in community

Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review

For patients experiencing acute coronary syndrome, early symptom recognition is paramount; this is challenging without chest pain presentation. The aims of this scoping review were to collate definitions, proportions, symptoms, risk factors and outcomes for presentations without cardiac chest pain. Full-text peer reviewed articles covering acute coronary syndrome symptoms without cardiac chest pain were included. MEDLINE, CINAHL, Scopus and Embase were systematically searched from 2000 to April 2023 with adult and English limiters; 41 articles were selected from 2,954. Dyspnoea was the most reported (n=39) and most prevalent symptom (11.6-72%). Neurological symptoms, fatigue/weakness, nausea/ vomiting, atypical chest pain and diaphoresis were also common. Advancing age appeared independently associated with presentations without cardiac chest pain; however, findings were mixed regarding other risk factors (sex and diabetes). Patients without cardiac chest pain had worse outcomes: increased mortality, morbidity, greater prehospital and intervention delays and suboptimal use of guideline driven care. There is a need for structured data collection, analysis and interpretation.

A study to explore the factors related to treatment seeking delay among adults diagnosed with acute myocardial infarction at KMCH, Coimbatore

Objective

The main aim of the study was to explore the factors causing delay in seeking treatment among adult patients diagnosed with CAAs acute myocardial infarction (AMI) and compare the factors between timely and late treatment seeking groups.

Method

A total of 93 subjects were included in the study diagnosed with AMI interviewed within 48 h of hospitalization. Data were collected from onset of symptoms to arrival at hospital on demography, clinical profile, clinical factors, cognitive factors and social support factors. Subjects were categorized in two study groups i.e. timely treatment seeking group (<120 min from onset of symptoms) and delayed treatment seeking group (>120 min from onset of symptoms).

Results

The minimum and maximum time took by subjects to seek treatment was 10 and 5450 min, respectively. The mean pain score of subjects who sought delayed treatment (2.2619) is less than those who sought timely treatment (3.3725). The mean knowledge score (12.2754), mean symptom perception (3.6667), mean perceived seriousness (4.7647) is more in subjects who sought timely treatment than those who sought delayed treatment (5.7381), (1.3095), (1.8333) respectively. The mean family support score (57.4492), mean non-family support score (24.902), mean social support score (48.3002) is more in timely treatment group than in delayed treatment seeking group (42.6829), (4.7619), (29.2138) respectively.

Conclusion

Decreased pain, knowledge about AMI, symptom perception, perceived seriousness respectively and inadequate family & non-family support i.e. social support were the factors related to treatment seeking delay among adults diagnosed with AMI.

[Acute pain in myocardial infarction: analysis of concept]

OBJECTIVE

To analyze the concept "sharp pain" in the context of acute myocardial infarction.

METHODS

Conceptual analysis method proposed by Walker and Avant. This makes it possible to clarify the concept of attributes. We conducted an integrative review to assist the search of studies published in 2006 and 2012, using the descriptors 'Acute Pain' and 'myocardial infarction', through consultation to Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Public/Publish Medline (PubMed) data.

RESULTS

A sample of 29 studies was selected in which the background identified was: reduction of myocardial perfusion and/or death of myocardial tissue; attributes: quality, location, time, duration and irradiation; and consequent: report of pain, dyspnea, high heart rate, nausea, vomiting, high blood pressure, high respiratory rate, sleep disturbance, diaphoresis, fatigue, paleness, weakness, anxiety and fear.

CONCLUSION

The findings have clarified the attributes of the concept sharp pain in myocardial infarction.