Study note
MedicineCardiology

Symptoms and physical signs of acute coronary syndromes

THE CONTEXT
Acute coronary syndromes can produce prolonged cardiac pain, autonomic features and signs of impaired myocardial function.

Symptoms

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Prolonged cardiac pain may involve the chest, throat, arms, epigastrium or back.
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Associated symptoms include anxiety, fear of impending death, nausea, vomiting, breathlessness and collapse or syncope.

Autonomic signs

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Sympathetic activation produces pallor, sweating and tachycardia.
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Vagal activation produces vomiting and bradycardia.

Impaired myocardial function and other findings

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Signs of impaired myocardial function include hypotension, oliguria, cold peripheries, narrow pulse pressure and raised jugular venous pressure.
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Other signs include a third heart sound, quiet first heart sound, diffuse apical impulse and lung crepitations.
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Low-grade fever may occur.
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