Severity of Chest Pain among Acute Myocardial Infarction Patients with Diagonal Branch Vessel Disease: A Pilot Study

Abstract

Introduction: Acute myocardial infarction (AMI) patients present with variable clinical manifestations such as shortness of breath, nausea, etc. among which chest pain is the most common. Previous studies have reported that the clinical presentation of AMI patients with branch vessel disease is indistinguishable from epicardial coronary vessel disease. However, our experience suggests patients with branch vessel disease experience severe chest pain, especially those with a diagonal branch. Therefore, we aim to study the association of chest pain severity with isolated diagonal branch vessel disease as a culprit vessel in AMI patients.Methods: It is a retrospective case-control design, where 10 cases and 40 historic controls were recruited in the study. Cases were patients with isolated diagonal branch disease, whereas controls were patients with epicardial vessel disease in AMI. We reviewed Coronary Angiograms of adult patients who presented with acute myocardial infarction and had undergone coronary angiography at Aga Khan University Hospital, Karachi (AKUH). Information on pain scores was measured using the Numeric Pain Rating Scale (NRS) before administration of analgesics. Other relevant variables were also recorded on a pre-structured questionnaire.Results: The mean age of all the participants in the study was 60 ± 11.0 years, with 16% of the patients being women. Among all AMI patients, the intensity of chest pain in patients with isolated diagonal branch vessel disease was 2.6 units higher as compared to those with other epicardial coronary vessel diseases (p-value: <0.001; 95% CI: 1.67 - 3.46).Conclusion: This preliminary study indicates severe chest pain can be a differentiating symptom in AMI patients with diagonal branch disease. It emphasizes clinicians to look for a possibility of a diagonal branch as a culprit vessel in AMI for better judgment, as it is often overlooked. future studies may be conducted at multiple centers for larger sample size and better generalizability.

Knowledge And Life-style Changes for Patients with Myocardial Infarction after Percutaneous Coronary Intervention

“…Finally, there were highly percentage of sample (59%) they not got health education before. In table two, regarding to the intensity, there were highly percentage of the sample had severe chest pain (69%) This was in line with Rahman et al (2019) who found that severe chest pain can be a differentiating symptom in myocardial infarction patients, where the intensity of chest pain in patients with myocardial infarction disease was 2.6 units higher as compared to those with other epicardial coronary vessel diseases.…”

An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report

“…Conversely, the pain in the left shoulder and the pectoral region showed up only 9 days after the initial symptom onset. Furthermore, the left shoulder pain has started concurrently with the autonomic symptoms as dyspnea, fatigue, shortness of breath and diaphoresis which has been recently linked to specific sites of myocardial infarction [72]. In this perspective, the progression of the hypoxic injuries induced in the myocardium following an inadequate exposure to oxygen supply could have affected specific sympathetic fibers, that even provoked the shift in somatic pain as well.…”