Rosh Emergency Medicine Practice Test

What is a common presenting symptom of a patient experiencing anterior myocardial infarction?

1. Neck pain

2. Left shoulder pain

3. Abdominal discomfort

4. Palpitations

The correct answer is: Left shoulder pain

Patients experiencing an anterior myocardial infarction (MI) commonly report left shoulder pain as a presenting symptom. This is largely due to the nerve pathways that convey pain sensations from the heart. The heart is innervated via the sympathetic nervous system, and because of the phenomenon known as referred pain, discomfort can be felt in areas that are not directly related to the heart itself. In the case of anterior MIs, the area of the heart that is most affected is supplied by the left anterior descending artery. The pain may radiate to the left shoulder or even down the arm, making it a classic symptom associated with heart issues. This presentation is consistent with the phenomenon of referred pain, where the brain misinterprets the source of the pain signals due to the overlapping nerve routes. Other symptoms, though common in different contexts, may not be as closely associated with anterior MI specifically when considering the classic presentation of pain. Neck pain might occur, but it is less specific than left shoulder pain. Abdominal discomfort can often be a sign of various conditions, including gastrointestinal issues. Palpitations might also happen but they are not specific presenting symptoms of anterior myocardial infarction as they can occur in a variety of conditions, including anxiety or other cardiac disorders. Thus,