UMEM Educational Pearls

Category: Cardiology

Title: painless ACS

Keywords: acute MI, MI, myocardial infarction, acute coronary syndrome, painless, presentations (PubMed Search)

Posted: 1/15/2012 by Amal Mattu, MD
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As many as 1/3 of patients with proven ACS have no chest pain at presentation. Among the more common alternative presentations (anginal equivalents) are dyspnea, diaphoresis, nausea/vomiting, and syncope/near-syncope.

Note also that the absence of pain does not confer a better prognosis. The overall in-hospital mortality rate for patients with painless presentations is 13% vs. 4.3% for patients with chest pain.


Brieger D, et al. Chest 2004; 126:461-469.