Elkandow, Ali Elhaj Mohammed
(2015)
Retrospective study of atypical presentation in cases
diagnosed as acute myocardial infarction.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: AMI presentation is consider fundamental part for diagnosis as a history
of chest pain usually lead the ED physicians to think about it or at least he/she is
considered as one of differential diagnosis from all life threatening conditions in thorax
region. In many patients, physician might face a challenge or may depend on his
experience or technology to figure out the cause of illness if the patient came without
chest pain although he/she finally diagnosed as AMI.
Objectives: In this study we have determined the prevalence of AMI in KB in north
Malaysian. In addition to that this study focused on three main atypical presentations
which include atypical chest pain, shortness of breathing and epigastric pain. Others
objectives include the outcome of each clinical presentations as well as clinical
approached in ED or medical ward. Furthermore, the study compared the duration of
admission for all typical and atypical presentations mentioned above. One of the
objectives of this study it assessed and correlated the common risk factors in term of comorbidities
which might affect the initial AMI presentation.
Methodology: The study design was a retrospective study of patients presenting for
treatment in Hospital Universiti Sains Malaysia from January 1, 2011, to December 31,
2012. This study non experimental research design using data collected from patient’s
files of folders. Data collection for this study took place during eight weeks period from
June 1, 2013, through August 1, 2013. Total of 442 patients with confirmed as AMI
enrolled from 1st of January 2011 to 31st of December 2012 in HUSM. Data was
analyzed by using SPSS version 22.
Main Outcome Measures: Prevalence of atypical AMI presentation include; atypical
chest pain, SOB, epigastric pain and others, Mortality rate and how patients were
approached in compare to those came with classical chest pain.
Results: Results from data of AMI patients were noticed atypical presentation more
common, than typical chest pain (58.6% vs. 41.4%). Mean age of AMI with typical
chest pain was found younger than AMI with less chest pain or those without chest pain
(58.57 vs. 63.12 years). Time to perform ECG, or started management also was
influenced by initial presentation this was appear faster e.g. in DOOR to ECG; in
typical presentation 10 minutes, while in atypical presentation the mean time was 37.27
minutes. Also the duration of admission was found to be longer in AMI with atypical
presentation (5 vs. 6 days). The mortality rate was higher in atypical presentation when
it compared with typical chest pain (9.7% vs. 2.5%).
Conclusions: Our results data were shown AMI without classical presentations were
common and patients at risk to be delayed in term of approach as well as management.
Patients were treated less aggressively in atypical presentation; also they could be
delayed or stayed longer in ED before admission. Moreover, usually they carry poor
prognosis and high mortality rate.
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