The clinical manifestations of patients experiencing an acute myocardial infarction are established from a variety of physical findings that are influenced by the severity and location of the infarction; in other words myocardial infarction can affect any area of the heart muscle depending on which coronary arteries it’s occluded or blocked (Gutierrez & Peterson, 2007). According to the The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology (2003), myocardial infarction is said to be related to the abnormal clinical finding, ECG, and abnormal serum level
of cardiac enzymes (CK-MB, cardiac troponin T) and this reflects the necrosis of myocardial tissue caused by prolong ischaemia, leading to pain. Pain is associated with activation of the sympathetic nervous system which causes the constriction of blood vessels and increases the workload of the heart (European Heart Journal (2003). Chest pain in particular is the most common physical findings of AMI. The pain is usually described as a “sudden substernal chest pain that radiates to the left arm, shoulder, jaw or neck and is the” hallmark of myocardial infarction “(Gould, 2006, p. 326).
Pain such as angina is only temporary but myocardial pain will last a lot longer and it is not relieved by rest and nitroglycerine (Virtual Medical Centre, 2010). Other symptoms and findings of AMI include pallor, diaphoresis, nausea, dizziness, dyspnea, marked anxiety and fear. Moreover, during a heart attack the patient may become restless, sweaty, anxious, and may experience a sense of impending death. The lips, hands, or feet may turn slightly blue (Brozenec & Russel, 2004). Other cardiovascular findings include heart murmurs and other abnormal heart sounds may be heard through a stethoscope (Virtual Medical Centre, 2010).
Mathew’s clinical presentation includes 5 hours of substernal chest pain radiating down his left arm. Mathew was also diaphoretic and short of breath and complained of nausea and dizziness. His ECG findings reveal premature ventricular contraction with ST elevation in anterior chest leads V1-V3( a confirmation of myocardial infarction). Serum levels of troponin, triglycerides, BGL, lipids, HbA all fall below or above their normal range values; and this abnormal finding are indicative of coronary heart disease (Medical Council of Canada (2010).