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Referred pain, also called reflective pain, [1] is pain perceived at a location other than the site of the painful stimulus.An example is the case of angina pectoris brought on by a myocardial infarction (heart attack), where pain is often felt in the left side of neck, left shoulder, and back rather than in the thorax (chest), the site of the injury.
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. [1] The most common symptom is retrosternal chest pain or discomfort that classically radiates to the left shoulder, arm, or jaw. [1]
CK-MB starts to rise 2-4 hours after infarction, peaks around 24 hours, and returns to normal after 48 hours. Since CK-MB returns to normal more quickly, it can be useful to diagnose reinfarction, a second infarction that happens after 48 hours but before troponin levels go back to normal. A second heart attack happens following 10% of MIs.
Acute coronary syndrome is subdivided in three scenarios depending primarily on the presence of electrocardiogram (ECG) changes and blood test results (a change in cardiac biomarkers such as troponin levels): [4] ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina. [5]
Chest pain due to coronary ischemia commonly radiates to the arm or neck. [7] Certain individuals such as women, diabetics, and the elderly may present with more varied symptoms. [8] If blood flow through the coronary arteries is stopped completely, cardiac muscle cells may die, known as a myocardial infarction, or heart attack. [9]
Referred pain is sharper, better localized, and less likely to be accompanied by autonomic or emotional signs. [10] [12] A good example of visceral pain that is common place and embodies the wide spectrum of clinical presentations discussed above is a myocardial infarction (MI), more commonly known as a heart
Also known as 'effort angina', this refers to the classic type of angina related to myocardial ischemia.A typical presentation of stable angina is that of chest discomfort and associated symptoms precipitated by some activity (running, walking, etc.) with minimal or non-existent symptoms at rest or after administration of sublingual nitroglycerin. [11]
Angor animi (also referred to as angina animi, [1] [2] Gairdner's disease [2] and also angina pectoris sine dolore [2]), in medicine, is a symptom defined as a patient's perception that they are in fact dying. Most cases of angor animi are found in patients with acute coronary syndrome (cardiac-related chest pain) such as myocardial infarction.
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