From the Guidelines
Approximately 5-10% of patients experiencing a myocardial infarction (MI) present with epigastric pain as their primary symptom. This estimate is based on the understanding that myocardial ischemia can manifest with various symptoms, including epigastric discomfort, as noted in the third universal definition of myocardial infarction 1. The presentation of epigastric pain in MI can be attributed to the shared nerve pathways between the heart and the upper digestive tract, leading to referred pain. Key factors to consider in patients presenting with epigastric pain include:
- The presence of cardiovascular risk factors
- The potential for atypical presentations, especially in women, the elderly, and those with diabetes
- The possibility of inferior wall MIs, which are more likely to present with epigastric symptoms Healthcare providers should maintain a high index of suspicion for MI when evaluating patients with epigastric pain, as prompt recognition is crucial for timely intervention and improved outcomes, considering the potential for delayed diagnosis and treatment due to the mistaken attribution of symptoms to gastrointestinal issues 1. The importance of careful evaluation is emphasized, especially in patients who may present with atypical symptoms or without symptoms, such as women, the elderly, diabetics, or post-operative and critically ill patients 1.
From the Research
Myocardial Infarction with Epigastric Pain
- The exact percentage of myocardial infarction (MI) patients presenting with epigastric pain is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that some patients with MI may present with atypical symptoms, including epigastric pain, which can lead to a delay in diagnosis and treatment 2, 4.
- A case report describes a 54-year-old male patient with MI who initially presented with epigastric pain, highlighting the importance of considering cardiac causes in patients with abdominal pain 2.
- Another study reports a case of a 68-year-old man who presented with epigastric pain and was diagnosed with both MI and acute pancreatitis, emphasizing the need for a thorough differential diagnosis in patients with abdominal pain 4.
- While the provided studies do not provide a specific percentage of MI patients with epigastric pain, they highlight the importance of considering cardiac causes in patients with abdominal pain and the need for prompt diagnosis and treatment to improve outcomes 2, 3, 4, 5, 6.