title: Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study.
abstract: We recently found craniofacial pain to be the sole symptom of an acute myocardial infarction (AMI) in 4% of patients. We hypothesized that this scenario is also true for symptoms of prodromal (pre-infarction) angina. We studied 326 consecutive patients who experienced myocardial ischemia. Intra-individual variability analyses with respect to ECG findings and pain characteristics were performed for those 150 patients who experienced at least one recurrent ischemic episode. AMI patients (n=113) were categorized into two subgroups: "abrupt onset" (n=81) and "prodromal angina" (n=32). Age, gender and risk factor comparisons were performed between groups. Craniofacial pain constituted the sole prodromal symptom of an AMI in 5% of patients. In those who experienced two ischemic episodes, women were more likely than men to experience craniofacial pain in both episodes (p<0.01). There was no statistically significant difference between episodes regarding either ECG findings or the use of the two typical pain quality descriptors "pressure" and "burning". This study is to our knowledge the first to report that craniofacial pain can be the only symptom of a pre-infarction angina. Craniofacial pain constitutes the sole prodromal AMI symptom in one out of 20 AMI patients. Recognition of this atypical symptom presentation is low because research on prodromal AMI symptoms has to date studied only patients with chest pain. To avoid a potentially fatal misdiagnosis, awareness of this clinical presentation needs to be brought to the attention of clinicians, researchers and the general public.
authors.affiliation: Department of General and Oral Physiology, Universidad de la República, School of Dentistry, Montevideo, Uruguay. mkreiner@netgate.com.uy.|Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Umeå University, Sweden.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Kreiner
authors.affiliation: Statistics Institute (IESTA), Universidad de la República, Montevideo, Uruguay.
authors.forename: Ramón
authors.initials: R
authors.lastname: Álvarez
authors.affiliation: Departments of Cardiology, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
authors.forename: Virginia
authors.initials: V
authors.lastname: Michelis
authors.affiliation: Departments of Public Health and Clinical Medicine, Umeå University and Heart Center, Umeå University Hospital, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Waldenström
authors.affiliation: Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Umeå University, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Isberg
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005157:Facial Pain / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D015995:Prevalence; D062706:Prodromal Symptoms
keywords: Myocardial infarction; facial pain; myocardial ischemia