Myocardial Infarction in Childhood Clinical Presentation

Updated: May 23, 2014
  • Author: Louis I Bezold, MD; Chief Editor: Stuart Berger, MD  more...
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Presentation

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

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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

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