Chest pain, dyspnea and other symptoms in patients with type 1 and 2 myocardial infarction. A literature review

Abstract

Background: Some studies investigated the leading demographic and clinical characteristics of patient with type 2 myocardial infarction (MI), but a comprehensive analysis between type 1 and 2 MI patients is lacking. Therefore, we reviewed current evidence about the difference in clinical signs and symptoms at presentation in patients with type 1 and 2 MI.

Materials and methods: We conducted an electronic search in Medline (with PubMed interface), Scopus and ISI Web of Science using the keywords "Type(-)2" or "Type II" and "myocardial infarction" and "chest pain" and "dyspnea" in "Title/Abstract/Keywords", with no language restriction, date limited from year 2007 to present, and study cohorts including more than 400 overall cases of MI.

Results: Overall, 37 documents were identified, but 33 were excluded since thoughtful comparison between the frequency of chest pain, dyspnea and other symptoms between patients with type 1 and type 2 MI was unavailable. Therefore, 4 studies were finally selected for analysis. Despite significant heterogeneity, the frequency of chest pain was consistently higher in patients with type 1 than type 2 MI (85% vs. 61%; p<0.001), whereas that of dyspnea and other symptoms was approximately 60-70% lower in type 1 than in type 2 MI. The odds ratio of chest pain was 3.5 in type 1 compared to type 2 MI, whereas that of dyspnea and other symptoms was 0.27 and 0.39 in type 1 compared to type 2 MI, respectively.

Conclusion: Our literature analysis suggests that "atypical" presentation may be more frequent in type 2 than in type 1 MI.

Keywords: Chest pain; Diagnosis; Myocardial infarction; Symptoms; Type 2.