History

Patients experiencing myocardial infarction (MI) in whom sudden death does not occur may present with a prodrome that can include any of the following features:

Chest pain (angina)
Palpitation
Dyspnea
Evidence of poor cardiac output
Weakness
Dizziness
Mental confusion
Irritability
Orthostasis
Presyncope
Syncope

Physical Examination

Examination findings vary, depending on the degree of disability and the duration of ischemia, and may include the following:

Altered level of consciousness – Lethargy, unconsciousness, irritability
Pulse abnormalities – Tachycardia, bradycardia, dysrhythmia
Respiratory embarrassment – Apnea, bradypnea, tachypnea, hyperpnea, nasal flaring, grunting, head bobbing, retractions (supraclavicular, intercostal, or subcostal), paradoxical respirations, rales, rubs, rhonchi, consolidation
Cardiac examination abnormalities – Hyperdynamic precordium, broad cardiac impulse, displaced apical beat, S₃, S₄, holosystolic murmur at the apex (mitral insufficiency), holosystolic murmur at the left lower sternal border (tricuspid insufficiency), loud pulmonic closure sound (P₂, pulmonary hypertension), diastolic murmur of aortic/pulmonary insufficiency, diastolic rumble of increased tricuspid/mitral flow
Hypotension and signs of low cardiac output – Cool skin, prolonged capillary refill time (CRFT), diaphoresis, poor turgor, peripheral cyanosis
Signs of cor pulmonale (right heart failure) – Jugular vein distention, hepatosplenomegaly, hepatojugular reflux, ascites, peripheral edema

Differential Diagnoses

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Media Gallery

Myocardial Infarction in Childhood. Electrocardiogram in an infant with anomalous origin of the left coronary artery from the pulmonary artery, demonstrating pathologic Q waves in leads I and aVL and diffuse ST-T wave changes consistent with an anterolateral infarction.

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Author

Louis I Bezold, MD Professor, Department of Pediatrics, Ohio State University College of Medicine; Director, Cardiology Consultation Service, Nationwide Children's Hospital

Louis I Bezold, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Society of Echocardiography, Society of Pediatric Echocardiography

Disclosure: Nothing to disclose.

Coauthor(s)

Kurt Pflieger, MD, FAAP Active Staff, Department of Pediatrics, Lake Pointe Medical Center

Kurt Pflieger, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Acknowledgements

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, New York Academy of Sciences, Society for Pediatric Research,Texas Medical Association, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose