Helf die from the infarction, and of these, half do so before they reach hospital. These deaths will only be avoided by measures which prevent the development of coronary disease. The pain lasts longer than angina, typically more than 20 min, and is resistant to treatment with sublingual or buccal nitrates. Associated symptoms are sweating, nausea, vomiting, breathlessness and collapse. Like angina, the pain may radiate to the arms, throat and jaw.
Many patients believe they are suffering from indigestion and consume antacids.
With the advent of thrombolytic therapy, it has become even more important to be aware of possible differential diagnoses in the patient with acute chest pain. There are no specific features that accompany myocardial infarction. During the acute phase, patients vary a great deal in their appearance, and the physical signs are largely those associated with pain and fear. The blood pressure tends to fall to lower than normal levels for the patient within a few hours of infarction but some may have a hypertensive reaction. The ECG changes of acute infarction may take some hours to develop and, occasionally, are absent competely.