Atypical Manifestation of Myocardial Ischemia in the Elderly

Ochiai, Marcelo Eidi; Lopes, NP; Buzo, Carolina Giusti; Pierri, Humberto

doi:10.5935/abc.20140025

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…DM and dementia are often associated with atypical symptoms for CAD [25][26][27] . DM has been considered the biggest factor related to atypical symptom of CAD, whereas several studies found no such association [27][28][29][30] . In patients with diabetes, atypical symptoms such as dyspnea, confusion, nausea, and fatigue may be the presenting complaint in approximately 40% of acute myocardial infarction 31,32) .…”

Section: Clinical Presentation Of Geriatric Syndromementioning

confidence: 99%

Atypical Clinical Presentation of Geriatric Syndrome in Elderly Patients With Pneumonia or Coronary Artery Disease

Jung

Yoon

Kim

et al. 2017

Ann Geriatr Med Res

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Background: Atypical symptoms often occur in elderly patients due to impaired homeostasis associated with age-related physiological changes and multiple pathologies. These atypical symptoms make diagnosis difficult and may partially increase morbidity and mortality. This study aimed to determine the incidence of atypical clinical presentation and to identify the effects of age and comorbidities on illness presentation in the elderly. Methods: Medical charts of 6,057 elderly patients (≥60 years) with pneumonia or coronary artery disease (CAD) admitted to 4 university hospitals were retrospectively reviewed. Determinants of atypical symptom presentation was evaluated using logistic regression analysis. The definition of atypical presentation was adapted from a previous study on atypical symptoms of pneumonia and CAD. Results: Among the 6,057 participants, 4,773 (78.8%) and 1,284 (21.2%) presented with typical and atypical symptoms, respectively. Among the participants, 24.8% CAD and 18.8% pneumonia patients had atypical presentations. Logistic regression analysis showed that factors associated with atypical presentation in CAD patients were age (≥85 years; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.81-4.03), higher pulse rate (OR, 1.01; 95% CI, 1.00-1.01), and number of comorbidities ≥4 (OR, 1.62; 95% CI, 1.13-2.32). In pneumonia patients, age (≥85 years; OR, 2.22; 95% CI, 1.49-3.31), body mass index (OR, 0.97; 95% CI, 0.94-0.99), and 1 comorbidity (OR, 1.53; 95% CI, 1.01-2.36) were statistically significant factors that increased atypical presentation. Conclusion: This study suggested that older patients frequently present atypical geriatric syndrome with acute illness, and age and comorbidity are statistically significant factors associated with atypical symptoms in CAD or pneumonia patients.

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Section: Clinical Presentation Of Geriatric Syndromementioning

confidence: 99%

Atypical Clinical Presentation of Geriatric Syndrome in Elderly Patients With Pneumonia or Coronary Artery Disease

Jung

Yoon

Kim

et al. 2017

Ann Geriatr Med Res

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“…Elderly patients have atypical pain compared to young though exact physiology unknown, changes in pain perception and altered ischemic thresholds may be contributory. 2,3 Only 47.5% of patients presented to the hospital within 12 hours of onset of symptoms. This accounted for one of the major reasons for not thrombolysing the patients.…”

Section: Discussionmentioning

confidence: 99%

“…In Worcester Heart Attack Study, chest pain was reported in less than half of the patients over age 75 years (45.5%) while dyspnea or cough (22%) and other symptoms like dizziness, arm numbness, headache, syncope, sweating, palpitations, nausea, weakness(32%) were more common. 2,3 Dyspnea in the elderly MI patient may be due to age-related diastolic dysfunction and associated pulmonary disease and Giddiness likely due to acute reduction in cardiac output in the setting of an aging brain and diminished autonomic responsiveness. Elderly patients have atypical pain compared to young though exact physiology unknown, changes in pain perception and altered ischemic thresholds may be contributory.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although, chest pain is the most common presentation of acute myocardial infarction (AMI) in elderly patients, there can be of predominance of other ischemic symptoms such as giddiness, dyspnoea, vomiting, sweating and epigastric pain in the absence of chest pain. 2,3 AMI is associated with significant higher mortality in the elderly compared with the young 4 . Yet the elderly people are treated less aggressively than the young.…”

Section: Introductionmentioning

confidence: 99%

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Clinical presentation, risk factors, complications and outcome of acute myocardial infarction in elderly patients

Sandhya

Mohanraj

2017

Int J Res Med Sci

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Background: Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. This article enlightens the clinical features, risk factors, complications, prognosis and outcome of Acute myocardial infarction in elderly patients. The objective of this study was to assess the risk factors, various symptoms, complications, prognosis and outcome of elderly patients with Acute myocardial Infarction (AMI). Methods: This is a prospective study done over a period of two years in a tertiary care hospital in South India. 80 elderly patients who were diagnosed as AMI were included in the study. Results: Among the eighty patients the majority of the patients belonged to the age group 60-69 years. Twenty percent of the patients presented without chest pain. The atypical presentations included dyspnoea, giddiness, vomiting, sweating and epigastric pain. Mortality rate was 20%. Conclusions: This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like shortness of breath, giddiness, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly though they may not present typically.Keywords: Acute myocardial infarction, Chest pain, Coronary heart disease, Elderly DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174669 Sandhya S et al. Int J Res Med Sci. 2017 Nov;5(11):4765-4769 International Journal of Research in Medical Sciences | November 2017 | Vol 5 | Issue 11 Page 4766 diagnosis of acute myocardial infarction. Eighty patients satisfying the inclusion criteria were included in the study. Duration of study was from February 2015 to November 2016. Inclusion criteria• Age-60 years or above (ICMR guidelines).• Typical ECG pattern a. ST segment elevation of ≥0.1 mV in at least 2 consecutive limb leads or ≥0.2mV in at least 2 consecutive chest leads for ST elevation MI b. 1 mm or more ST segment depression c. Definite T wave inversions and pathological evolution of q waves (>0.04s) d. New onset LBBB • Elevated cardiac enzyme levels (CKMB or Troponin T). Exclusion criteria• Patients with stable or unstable angina.Patients presenting to our casualty with symptoms of acute myocardial infarction -chest pain, giddiness, shortness of breath, epigastric pain-were evaluated with 12 lead resting ECG and cardiac enzymes (CK MB and Trop T). Those who had ECG findings of AMI and elevation of enzymes were shifted to coronary care unit and treated/thrombolysed according to the AMI protocol.History, examination and investigation findings of these patients were recorded in the Proforma. The complications these patients developed in the hospital were recorded. The investigations done included random and fasting blood sugar, fasting lipid profile, Blood Urea, serum creatinine, electrolytes, Chest X ray and 2DEchocardiogram. RES...

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“…Observou-se uma redução na capacidade do SMCR de classificar de forma adequada os pacientes com dor torácica, conforme a idade dessa população foi aumentando. Tendo em vista que há uma maior prevalência de quadros atípicos de SCA e IAM na população idosa (63) , este resultado parece confirmar achados de estudos anteriores (28,33,34) (49) , ou seja, nesse caso as mortes podem não ter sofrido influência de erros na classificação de risco.…”

Section: Discussionunclassified

Sensibilidade e especificidade do Sistema Manchester de Classificação de Risco na priorização de pacientes com infarto agudo do miocárdio que apresentam dor torácica

Nishi

Polak

Cruz

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Atypical Manifestation of Myocardial Ischemia in the Elderly

Cited by 7 publications

References 14 publications

Atypical Clinical Presentation of Geriatric Syndrome in Elderly Patients With Pneumonia or Coronary Artery Disease

Atypical Clinical Presentation of Geriatric Syndrome in Elderly Patients With Pneumonia or Coronary Artery Disease

Clinical presentation, risk factors, complications and outcome of acute myocardial infarction in elderly patients

Sensibilidade e especificidade do Sistema Manchester de Classificação de Risco na priorização de pacientes com infarto agudo do miocárdio que apresentam dor torácica

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