How to spot a heart attack? Acute Myocardial Infarction Signs and Symptoms.

A myocardial infarction also known as a heart attack, occurs when blood flow decreases or stops to the heart and it causes the damage of the heart muscle.
The most common symptom of myocardial infarction is chest pain. But chest pain can be caused by lots of conditions and only 5 % of them are life-threatening.
That’s why it is crucial to differentiate heart attack from other conditions.
We will discuss symptoms, that increase the likelihood of myocardial infarction.

The most common symptom is chest pain, or discomfort, which Radiates into the shoulder or arm.
This is a classical sign. And if the pain radiates to the right arm or shoulder it increases the risk of myocardial infarction.
If pain radiates in both arms or shoulders, it is also strong evidence for myocardial infarction. Sometimes pain radiates in the left arm.
Pain associated with exertion or physical activity, also indicates myocardial ischemia.
Cold sweats and diaphoresis also sign of myocardial infarction.
The pain associated with Myocardial Infarction is usually diffuse, does not change with position, and lasts for more than 20 minutes, but not hours.
Nausea and vomiting also suggest risk of myocardial infarction.
Pressure or tightness is typical presentation of myocardial ischemic pain.
But, some patients explain it as dyspnea or unexplained anxiety.

The severity of discomfort is not considered important market. Because it can vary widely.
Signs which decreases likelihood of myocardial infarction:
Knifelike, stabbing, or pleuritic pain which can be change during breathing.
Burning-like pain also can decrease probability of myocardial infarction, because its more common during acid reflux.
If pain increases with palpation or is reproduced during movement, it more indicates trauma, strain, or inflammation, rather than myocardial infarction.
substernal location with radiation to the neck, jaw, shoulder, or arms is typical of myocardial ischemic
discomfort.
But pain under the nipples, inframammary location, or if pthe atient can point exact pain location by finger, it importantly decreases the risk of myocardial infarction.
above the mandible or below the epigastrium is rarely angina.
Myocardial Ischemic Pain increases in several minutes and is usually coincident with physical exertion.
If pain lasts only several seconds, or it starts abruptly, or is intense and constant, lasting for several hours or days, usually it is not myocardial ischemia.

Patients with myocardial ischemic pain usually prefer to rest, sit, or stop walking.
However, in some cases pain also relieves if they continue or increase physical exertion. This phenomenon is called “warm-up angina”
Dyspnea can be an important symptom of myocardial infarction, especially among the elder population, where other symptoms aren’t very clearly presented.
Dyspnea can be presented in other diseases, but most cases directly correlate with cardiopulmonary diseases.
Patients sometimes clenched fist held over the chest to describe ischemic chest pain. This sign is called Levine's sign. although a prospective observational study showed it had a poor positive predictive value.
Patient Age is an important predictor of myocardial infarction.
Myocardial ischemia is less common at a young age.
Common risk factors for myocardial infarction are the age of 45 and more. And sex male.
Women have a high chance of atypical symptoms of myocardial infarction.
Such symptoms include: Fatigue, extreme tiredness, fainting dizziness, sweating, nausea, or vomiting, and these symptoms may also occur without any pain at all.
Sometimes: palpitations, back pain, labored breath, vomiting, and left arm pain are more common in women than men.

Laboratory:
Cardiac troponin is the preferred biomarker for the diagnosis of Myocardial Infarction and should be measured in all patients suspected of myocardial ischemia.
In patients presenting more than 2–3 h after symptom onset, if cardiac troponin is below the limit of detection , using a high sensitivity assay, it almost definitively excludes myocardial infarction.
Other laboratory assessments may include the D-dimer test to aid in the exclusion of pulmonary embolism.

Typically, chest pain because of ischemia, be it unstable angina or myocardial infarction, lessens with the use of nitroglycerin, but nitroglycerin may also relieve chest pain arising from non-cardiac causes.