Coronary heart disease (KHK) & myocardial infarction in the Kenntnisprüfung

Which symptoms are typical of an acute myocardial infarction?

• Stabbing, pinpoint pain on breathing in, which can be triggered by pressing on the ribs
• A feeling of pressure and tightness behind the breastbone, radiating to the arm/jaw, fear of death, cold sweat
• Chest pain that disappears with movement and change of position, with pink, warm and dry skin
• Burning pain behind the breastbone after eating that gets worse lying down and causes belching

Explanation: Crushing retrosternal pain with radiation, autonomic signs and fear is the key picture. Stabbing pain that depends on breathing tends to speak against an infarction.

How can a myocardial infarction present in women and people with diabetes?

• Just as in men: without retrosternal chest pain an infarction is practically ruled out
• Particularly severely in people with diabetes, because the neuropathy intensifies pain sensation in the heart
• Atypically: nausea, upper abdominal pain, shortness of breath, unusual tiredness — the pain may be absent
• Mainly through calf pain when walking, because the circulatory disorder affects the legs first

Explanation: Women and people with diabetes (silent infarctions due to neuropathy!) often show atypical pictures. Anyone who only waits for chest pain will miss these infarctions — an important point in patient observation (Krankenbeobachtung).