# Difference between Angina and AMI



## JMFL (Sep 4, 2010)

Hey guys.  Im confused about the difference between Angina and AMI when it comes to signs/symptoms.  On a call how can you tell the two apart?


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## Veneficus (Sep 4, 2010)

JMFL said:


> Hey guys.  Im confused about the difference between Angina and AMI when it comes to signs/symptoms.  *On a call how can you tell the two apart*?



Well if you have an I stat troponin machine that could tell you.

You could do a 12 lead, but prinzmetals angina also causes ST elevation.

Best to just call it ACS and treat it as such.


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## EMTinNEPA (Sep 4, 2010)

As your typical ground paramedic, distinguishing between an AMI and angina is often not within your diagnostic capabilities.  No true way to distinguish without measuring Troponin and CK.  While a 12-lead can help you distinguish is there is a STEMI occuring, there is no pre-hospital test to distinguish NSTEMI vs. Angina.  However, Angina responds well to nitrates, so treat the same way you would treat any suspected ACS... oxygen, 12-lead, IV, ASA, Nitro, and (if necessary) Morphine.  Plus, unstable angina may trigger or be a sign of an impending MI.


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## mgr22 (Sep 4, 2010)

JMFL said:


> Hey guys.  Im confused about the difference between Angina and AMI when it comes to signs/symptoms.  On a call how can you tell the two apart?



As others have advised, treat s/s of either as a possible MI. However, stable angina usually has predictable onset with exertion, and relief with rest, oxygen and/or NTG (predictable by the patient, not by you).


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## ZVNEMT (Sep 5, 2010)

at my company our "boss/supervisor/owner" wants us to treat all chest pain as stable, his reasoning; "i have chest pain three times a week and i never go to the hospital"

we ignore him and still treat all chest pain as a possible MI


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## rescue99 (Sep 5, 2010)

JMFL said:


> Hey guys.  Im confused about the difference between Angina and AMI when it comes to signs/symptoms.  On a call how can you tell the two apart?



Chest pain, often described as "crushing", brought on by activity and relieved by rest "usually" implies angina. Without testing no diagnosis can be made.


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## mgr22 (Sep 6, 2010)

ZVNEMT said:


> at my company our "boss/supervisor/owner" wants us to treat all chest pain as stable, his reasoning; "i have chest pain three times a week and i never go to the hospital"
> 
> we ignore him and still treat all chest pain as a possible MI



Is it possible you misunderstood? I mean, even if your company were run by someone who neither knew nor cared about good medicine, wouldn't there still be a business motive, i.e. more intervention = more revenue?


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## Too Old To Work (Sep 15, 2010)

Often you can't. A 12 Lead is a good way to determine STEMI, but it's not infallible since a good percentage of MIs do not have ST segment changes. As Rescue99 wrote, chest pain with exertion relieved by rest, O2, and or NTG is generally considered to be anginal in origin. The treatment is essentially the same, but relief is an indicator of angina. Also, while on the subject, be aware of anginal equivilents since a good percentage of anginal patients (and MI patients) don't have chest pain, but do have equivilent symptoms. Dyspnea one, perhaps the most common one. 

Chest pain from an MI often, but always, comes on at rest or will awaken the patient from sleep. Stable angina does not present that way, so at the least you are looking at a patient with unstable angina. 

Which is why many patients end up in the cath lab, but end up not having an MI. Even experienced physicians have a hard time differentiating cardiac chest pain from non cardiac chest pain. That's why discharges from EDs of patients who presented with chest pain is one of the highest risk activities a doctor engages in. They often come back in with worsening symptoms. Sometimes they come back in in cardiac arrest. Litigatio often results. 

Doctors even have a saying about it, "No good ever comes of a conversation that starts out, "Remember that patient you sent home the other day?"


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## 18G (Sep 15, 2010)

Angina is relieved by rest (and prescribed nitro) and is predictable with its onset and dissipation. This is a pretty standard definition. Patients at home who have a cardiac history (ie angina) are prescribed nitro and told by their doctor with the onset of chest pain to rest and take (3) nitro's... if no relief after (3), call 911. If the pain is persisting despite rest (reducing the oxygen demand of the heart) and NTG (improving coronary blood flow), than that is good indication that the chest pain is indicating progression to something other than angina like an MI.

An MI is usually indicated by persistent chest pain not relieved by rest or NTG and sometimes will have a different quality than a patients typical angina pain (if they have hx of such). 

In the field, as others have mentioned... were not gonna be able to differentiate between angina and an MI. Any patient complaining of a cardiac type chest pain is assumed to be having an MI and treated as such. It's too risky to shrug off what we may think to be simple angina and not be aggressive in delivering care. 

There is also a type of angina called "unstable" angina that patients can progress to.


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## LondonMedic (Sep 16, 2010)

EMTinNEPA said:


> Angina responds well to nitrates,


Not a myth, but this is definitely an overstated fact.


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## LondonMedic (Sep 16, 2010)

18G said:


> Angina is relieved by rest (and prescribed nitro) and is predictable with its onset and dissipation.
> ...
> There is also a type of angina called "unstable" angina that patients can progress to.


You don't have to progress to unstable angina.

To be blunt, short of good going ST elevation or a positive trop there is no way to tell angina, unstable angina or an MI apart and trying to do so is, in my opinion, dangerous and a waste of time since the management is the same - MOVE, MONA and gasoline.


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## Matthew Rodewald (Feb 28, 2018)

JMFL said:


> Hey guys.  Im confused about the difference between Angina and AMI when it comes to signs/symptoms.  On a call how can you tell the two apart?


Angina Pain- Chest pain with no damage to the heart. Pain is described as a tightness or pressure in the chest, and may radiate to the neck, lower jaw, left arm, and left shoulder.

AMI Pain- Pain is sudden substernal chest pain radiates to left neck and usually described as severe, steady, and crushing. Hypotension, weak rapid pulse, and low grade fever


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## rescue1 (Feb 28, 2018)

All the different names and types of chest pain always confused me, so here's a detailed breakdown:

Stable angina is exertional chest pain/pressure that would classically present with ST depression during the attack but a normal EKG in between attacks. Like others have said, it would classically be relieved by nitro. It's caused by myocardial oxygen demand exceeding supply due to atherosclerosis, usually because of exertion.

Acute coronary syndrome:

1) Unstable angina is chest pain without cardiac biomarkers (CPK, troponins) and possibly ST depression/T wave inversion. It is caused by incomplete occlusion of a coronary vessel at rest. New onset angina is often considered unstable until cardiac testing can be done.

2) NSTEMI is an acute occlusion of a coronary vessel causing partial thickness ischemia of the myocardial wall. Is definitionally elevated cardiac biomarkers in the absence of ST segment elevation. It also classically presents with ST segment depression. 

3) STEMI: A thrombus causing full thickness myocardial wall infarction. ST segment elevation + elevated cardiac biomarkers.

NSTEMIs and STEMIs are considered types of acute myocardial infarction, the other two are not. 

As you can see, the only one you can diagnose with any confidence in the ambulance is a STEMI (on EKG). There is no way to differentiate them based on types of chest pain or location of the pain. Even reproducible chest pain does not completely rule out ACS (though it does make it much less likely). 

All of them are treated the same way, 12 lead, vitals, aspirin, IV +/- fluids as needed, nitro if their pressure is acceptable, oxygen if they're hypoxic, morphine if the pain is severe, transport.

Hope this helps


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## CALEMT (Mar 1, 2018)

I would certainly hope that he’s figured it out in the 8 years this thread has been up.


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## DesertMedic66 (Mar 2, 2018)

CALEMT said:


> I would certainly hope that he’s figured it out in the 8 years this thread has been up.


Dang. You beat me to it. I wasn’t even out of EMT school yet when this post went up haha


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## CALEMT (Mar 2, 2018)

DesertMedic66 said:


> Dang. You beat me to it. I wasn’t even out of EMT school yet when this post went up haha



I was a sophomore in high school at the time of the OP's post...


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## VentMonkey (Mar 2, 2018)

DesertMedic66 said:


> I wasn’t even out of EMT school yet when this post went up haha





CALEMT said:


> I was a sophomore in high school at the time of the OP's post...


...baby medics.


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## VFlutter (Mar 2, 2018)

I just started nursing school


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## rescue1 (Mar 4, 2018)

Haha I didn't even see the old dates.

I had just passed my EMT-B practical and probably didn't even know what a STEMI was when this went up.


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## NPO (Mar 4, 2018)

DesertMedic66 said:


> Dang. You beat me to it. I wasn’t even out of EMT school yet when this post went up haha


I had just finished high school and started my EMT class. I knew enough to be dangerous and not enough to realize it.


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