- Chest pain
- Severe, diffuse steady substernal pain of a crushing and squeezing nature
- Not relieved by rest or sublingual vasodilator therapy, but requires opioids
- May radiate to the arms (usually the left), shoulders, neck, back, and/or jaw
- Continues for more than 15 minutes
- May produce anxiety and fear, resulting in an increase in heart rate, BP, and respiratory rate
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- Diaphoresis, cool clammy skin, facial pallor
- Hypertension or hypotension
- Bradycardia or tachycardia
- Premature ventricular and/or atrial beats
- Palpitations, severe anxiety, dyspnea
- Disorientation, confusion, restlessness
- Fainting, marked weakness
- Nausea, vomiting, hiccups
- Atypical symptoms: epigastric or abdominal distress, dull aching or tingling sensations, shortness of breath, extreme fatigue
NURSING ALERT
Many patients do not have symptoms; these are “silent MIs. Nevertheless, there still is resultant damage to the heart. Women usually present with atypical and/or vague complaints (eg, epigastric pain, feeling tired).
GERONTOLOGIC ALERT
Elderly patients are more likely to experience silent MIs or have atypical symptoms, such as hypotension, low body temperature, vague complaints of discomfort, mild perspiration, strokelike symptoms, dizziness, change in sensorium.