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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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

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, S 3, S 4, holosystolic murmur at the apex (mitral insufficiency), holosystolic murmur at the left lower sternal border (tricuspid insufficiency), loud pulmonic closure sound (P 2, 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