Correlation between symptomatology and site of acute myocardial infarction

Objective: We determined the occurrence of presenting symptoms in patients with different sites of acute myocardial infarction after controlling for age and conventional risk factors. Methods: Hospital-based study of patients hospitalized because of first anterior (n=731), inferior (n=719) and lateral (n=96) infarction in Clinical Hospital Split between 1990 and 1994. Data form about presenting symptoms and clinical profile was completed for each patient. Results: Anterior infarctions were more often presented by headache (adjusted odds ratio (OR)=1.67, 95%CI=1.06–2.62), weakness (OR=1.60, 95%CI=1.31–1.96), dyspnea (OR=1.40, 95%CI=1.14–1.72), cough (OR=2.24, 95%CI=1.59–3.16), vertigo (OR=2.04, 95%CI=1.40–2.99) and tinnitus (OR=2.09, 95%CI=1.06–4.14). Inferior infarctions were more often associated with epigastric (OR=1.71, 95%CI=1.30–2.24), neck (OR=1.47, 95%CI=1.10–1.98) and jaw pain (OR=2.16, 95%CI=1.42–3.27), sweating (OR=1.56, 95%CI=1.27–1.92), nausea (OR=2.01, 95%CI=l.64–2.46), vomiting (OR=1.55, 95%CI=1.22–1.97), belching (OR=1.57, 95%CI=1.21–2.03) and hiccups (OR=2.88, 95%CI=1.53–5.42). Patients with lateral infarctions were more likely to complain of left arm (OR=1.80, 95%CI=1.07–3.05), left shoulder (OR=1.82, 95%CI=1.19–2.79) and back pain (OR=2.40, 95%CI=1.28–4.46). Pain was less frequently reported by hypercholesterolemic (P=l.4×10−7), patients over 70 years (P=0.002), women (P=0.0007) and those with non-triggered infarction (P=0.0009), whereas those over 70 (P=1.7×10−6) and men (P=0.0003) were less likely to report other relevant symptoms. Conclusions: Our study suggests a linkage between different infarction sites and specific groups of symptoms. Furthermore, coronary patients should give their full attention to non-specific symptoms and any kind of discomfort.