Levine sign

[gothamprince]

the classic myocardial infarction [Heart attack] presents with chest pain

[gothamprince]

the chest pain has various causes but the chest pain due to decreased blood supply to the heart muscle is called angina

[gothamprince]

we will discuss other causes of chest pain briefly and how to differentiate them from angina

[AndhraPickles]

Great unclassical and atypical case presentation...

[gothamprince]

16 minutes ago, AndhraPickles said:

Great unclassical and atypical case presentation...

are you a doctor?

[gothamprince]

angina can be classified into stable angina and acute coronary syndromes

acute coronary syndromes inturn consists of unstable angina and acute myocardial infarction

[gothamprince]

these conditions are more of discomfort than pain

it is deep seated rather than superficial

stable angina is felt beneath the breast bone (sternum) and little predilected towards the left side ,commonly the pain then radiates to the neck, throat (choking sensation), upper back, interscapular areas, epigastrium(heart burn), shoulders (arthritis), the inner aspect of the left arm usually( pins and needles sensation)

some patients may even consult a dentist thinking the jaw pain is due to toothache

[gothamprince]

Stable angina is brought out by 4 E'S

EXERTION

EMOTIONAL STRESS

EXPOSURE TO COLD

EATING A HEAVY MEAL

[gothamprince]

Stable angina is due to blockage of coronary blood vessels  which supply heart muscle by cholesterol and other lipids this process is called atherosclerosis

this pain lasts for 2-15 minutes

this pain is relieved by rest or by taking nitroglycerin tablet

there is no permenant damage to heart muscle (myocardium) in this case

 

 

[gothamprince]

the best position for patient experiencing stable angina or any angina for that matter is sitting and taking rest but not lying down as load on the hear increases in this case which causes more pain and may cause more damage

[gothamprince]

coming to the Unstable angina 

Unstable angina the quality of pain similar but it is more severe and lasts longer than 20 minutes and the intensity increases with time unlike stable angina where the intensity is constant 

this pain may even occur at rest 

this pain does not reduce on taking rest and require higher dosage of nitroglycerin for pain to subside

even in unstable angina there is no permanent damage to the heart muscle

but if it not treated immediately may lead to Myocardial infarction also called heart attack which is death of muscle tissue which is a permanent damage

[gothamprince]

16 hours ago, gothamprince said:

the patient with the chest pain  may have difficulty in describing the pain and makes a clenched fist over the sternum

this is the most classic hand gesture suggesting angina

this is called LEVINE SIGN

[gothamprince]

the mechanism behind the unstable angina and why it can occur even at rest

as i described earlier there is occlusion of blood vessels that supply blood to heart that are coronary arteries by atherosclerosis a part of cholesterol substance may break free and blood clot starts forming on the remaing part inside the blood vessel thus almost occluding the artery suddenly

this process can occur even in rest , so this is sudden onset 

the common time for heart attack to occur is from 6AM to 12PM during the time viscosity of blood is high and more chance to clot

[gothamprince]

acute myocardial infarction also called heart attack

the chest pain is typical anginal pain in location, and it's radiation but much more severe lasts longer than 30 minutes and usually lasts for several hours unless narcotic pain killers are used or aggressive intervention has been done such as angioplasty

[gothamprince]

18 hours ago, gothamprince said:

nausea and vomiting is usually associated with heart attack