Abstract              Objectives: To study atypical presentation of Acute Myocardial Infarction (AMI) and time delay from symptom onset to hospital presentation in local population. Subjects and Methods: Acute Myocardial infarction (AMI) patients (316) admitted to Government Bidar Institute of Medical Sciences (BRIMS) Hospital., Bidar, situated in a semi-urban backward district of north Karnataka, studied over a period of 1 years with atypical(without chest pain) and typical(with chest pain) presentation along with site of infarct, risk factors, time delay from symptom onset to hospital presentation thrombolysis and mortality were studied. Observations: Out of 316 AMI studied, 273(86.39%) presented with chest pain and 43(13.60%) with atypical symptoms and mean age being 51.3 and 56.3 years respectively. Dyspnoea(39.53%) being most common atypical symptom followed by vomiting(32.55%) and syncope(25.58%), noted frequently in inferior wall Myocardial infarction (IWMI 23/43patients-53.48%). When considered atypical Vs typical, atypical presentation was associated with increased percentage in females (32.55% vs 21.97%) and hypertensives, equal incidence in patients with angina and diabetes. More atypical Myocardial Infarction (MI) delayed (>6 hours) presenting to hospital (44.19% vs. 30.04%), underwent lesser (41.86% vs. 61.53% ) thrombolysis(statistically significant) and more mortality(30.23% vs. 19.41%). Conclusion: A higher index of suspicion is needed for early recognition of Atypical MI associated with older age group, females, hypertensives and presenting with dyspnoea, vomiting, syncope, to avoid time-delay in reperfusion therapy and subsequent mortality.

Key Words: Acute Myocardial Infarction (AMI), Atypical AMI, Typical AMI.