Acute Coronary Syndrome Symptoms
Patient may feel sensation
of chest pressure or heaviness, which is reproduced by activities or conditions that increase
myocardial oxygen demand.
* Not all patients experience chest discomfort.
Some present with only neck, jaw, ear, arm, or epigastric discomfort.
* Other symptoms, such as shortness of breath
breathlessness or severe weakness, may represent anginal equivalents.
* A patient may present to the Emergency
department because of a change in pattern or severity of symptoms.
* Other associated features are weakness,
lightheadedness, diaphoresis, or nausea and vomiting.
* Patients may complain of the
tachycardia or bradycardia
o Pain, which
is usually described as pressure, squeezing, or a burning sensation across the precordium and may
radiate to the neck, shoulder, jaw, back, upper abdomen, or arms
dyspnea breathlessness that resolves with pain or rest
(increased perspiration) from sympathetic discharge
o Nausea from
with diabetes and elderly patients are more likely to have atypical presentations and offer only
vague complaints, such as weakness, dyspnea, lightheadedness, and nausea.
episodic pain lasting 5-15 minutes
o Provoked by
o Relieved by
rest or nitroglycerin
Patients have increased risk for adverse cardiac events, such as MI
or death. Three clinically distinct forms exist, as follows:
o Angina of
increasing frequency or duration or refractory to nitroglycerin
o Angina at
angina (Prinzmetal angina)
primarily at rest
o Triggered by
o Thought to
be due to coronary vasospasm
persons and those with diabetes may have particularly subtle presentations and may complain of
fatigue, syncope, or weakness. Elderly persons may also present with only altered mental status.
Those with preexisting altered mental status or dementia may have no recollection of recent
symptoms and may have no complaints whatsoever.
* As many
as half of cases of ACS are clinically silent in that they do not cause the classic symptoms
described above and consequently go unrecognized by the patient. Maintain a high index of
suspicion for ACS especially when evaluating women, patients with diabetes, older patients,
patients with dementia, and those with a history of heart failure patients.