Abdominal form of myocardial infarction

The abdominal form of myocardial infarction is a type of myocardial infarction (heart attack) in which the ischemic process (lack of blood supply) and necrosis (tissue death) involve an area of the heart that is located in the front of the abdomen, or the "abdominal" region. This refers to the lower part of the front wall of the heart, which is normally supplied with blood by branches of the left coronary artery.

The abdominal form of myocardial infarction can present with a variety of clinical manifestations but is often accompanied by pain and discomfort in the abdomen, subchest, or epigastrium (upper abdomen, under the breast). This can be confusing because the symptoms may be similar to those of gastrointestinal disorders or abdominal pain.

Abdominal myocardial infarction usually requires urgent medical attention and diagnosis, including an electrocardiogram (ECG), biochemical blood tests (to detect markers of myocardial damage such as troponins) and other cardiac testing. Treatment includes emergency care to restore normal blood supply to the heart, such as coronary angiography and, if necessary, angioplasty or coronary artery bypass grafting.

The abdominal form of myocardial infarction can be life-threatening, and it is important to seek medical attention immediately if a myocardial infarction is suspected, even if the symptoms appear to be related to the abdominal region. Effective and timely treatment can save the patient's life and prevent serious complications.

Epidemiology

The prevalence of atypical manifestations is high, epidemiologic studies show that 26% of patients with myocardial infarction may have typical chest pain, [1] and atypical manifestations of myocardial infarction account for almost 34%. [2]

Symptoms of the abdominal myocardial infarction.

The abdominal form of myocardial infarction may have distinctive signs and symptoms from other forms of myocardial infarction, such as typical angina pectoris or anterior wall myocardial infarction. The main distinguishing features of this form may include:

1. Abdominal pain: One of the most characteristic signs of abdominal myocardial infarction is pain or discomfort in the abdominal region, especially in the epigastrium (under the chest). This pain may be moderate or intense.
2. Vomiting and Nausea: Patients with abdominal myocardial infarction may experience nausea and sometimes vomiting.
3. Absence of typical symptoms of angina: Some patients with this form of myocardial infarction may not have typical angina such as burning chest pain that irradiates to the left arm, shoulder, or jaw.
4. Gastric disorders: Myocardial infarction may be accompanied by transient gastric disorders, including diarrhea.
5. Loss of consciousness or dizziness: In some cases, patients may lose consciousness or feel dizzy.
6. Symptoms of Anemia: Because myocardial infarction can affect blood flow and blood production, patients may experience symptoms of anemia such as weakness and fatigue.

It is important to note that the symptoms of abdominal myocardial infarction can vary widely and will not always be the same in all patients. If pain or discomfort in the abdominal area occurs, especially in individuals with risk factors for myocardial infarction, medical attention should be sought immediately. [3]

Diagnostics of the abdominal myocardial infarction.

Diagnosing the abdominal form of myocardial infarction (MI) can be difficult because of the unusual location of symptoms. However, modern medical diagnostic techniques can accurately identify this form of IM. Here are the main diagnostic methods that can be used:

1. Electrocardiography (ECG): ECG is the primary method of diagnosing MI. It records the electrical activity of the heart and identifies changes associated with infarction. In the abdominal form of IM, ECG may show specific changes such as ST segment shifts and Q tooth changes characteristic of myocardial infarction.
2. Measuring levels of markers of myocardial injury: Important biomarkers for the diagnosis of MI are troponins and creatine phosphokinase-MB (CPK-MB). Elevated levels of these markers may indicate myocardial damage, which can confirm the diagnosis.
3. Echocardiography: Echocardiography (cardiac ultrasound) is used to visualize the structures of the heart and assess its function. It can help detect changes in the movement of the heart walls, which may be associated with a heart attack.
4. Computed tomography (CT) or magnetic resonance imaging (MRI): These imaging techniques provide a more detailed look at the structures of the heart and blood vessels and can be used for additional diagnosis.
5. Coronarography: Coronarography is an invasive test in which a contrast agent is injected into the coronary arteries of the heart to determine the level of blockage or narrowing of the vessels, which can cause MI. It can be performed to better localize and assess infarction.
6. Additional tests: In some cases, additional tests such as blood tests, renal function assessment and others may be performed to assess the patient's general condition and identify risk factors. [4]

Differential diagnosis

The differential diagnosis of abdominal IM involves identifying and distinguishing it from other conditions that may mimic symptoms or cause abdominal pain. The following are some of the possible diagnoses to consider:

1. Acute bowel obstruction: Acute bowel obstruction can cause intense abdominal pain and nausea. It requires emergency medical attention and surgical intervention.
2. Pancreatitis: Acute pancreatitis can also be accompanied by severe pain in the upper abdomen. Patients may experience nausea, vomiting and fever.
3. Gastritis or peptic ulcer: Inflammation of the mucous membrane of the stomach or duodenum can cause upper abdominal pain.
4. Peritonitis: Acute peritonitis, an inflammation of the abdominal cavity, can also cause intense abdominal pain and requires immediate medical attention.
5. Gallbladder Colic: Gallbladder disease, such as cholecystitis or cholelithiasis, can cause pain in the right upper quadrant of the abdomen.
6. Pericarditis: Acute pericarditis, inflammation of the lining around the heart (pericardium), can mimic the symptoms of IM, including abdominal pain.
7. Gastroesophageal Reflux: A reflux disease in which acidic fluid from the stomach backs up into the esophagus can cause discomfort and pain in the upper abdominal area.
8. Other gastrointestinal problems: Various other gastrointestinal problems, such as irritable bowel syndrome, can also mimic the symptoms of IM.

A comprehensive evaluation, including physical examination, laboratory tests (including measurement of biomarkers of heart damage such as troponins), electrocardiography (ECG), and educational techniques (such as echocardiography), is necessary to accurately diagnose abdominal MI and rule out other causes of abdominal pain. It is important to see your doctor immediately if you suspect abdominal MI or severe abdominal pain, especially if it is accompanied by other symptoms of MI such as shortness of breath, chest pain, nausea, or loss of consciousness.

Literature

• Shlyakhto, E. V. Cardiology: national guide / ed. By E. V. Shlyakhto. - 2nd ed., revision and addendum - Moscow: GEOTAR-Media, 2021
• Cardiology according to Hurst. Volumes 1, 2, 3. GEOTAR-Media, 2023.