Acute Myocardial Infarction: Diagnostic Difficulties and Outcome in Advanced Old Age

Abstract

The diagnostic features and outcome of acute myocardial infarction in 100 very elderly (aged 85 years or more) hospitalized patients are reviewed and compared with those in a group of younger elderly (aged 65-84 years). The diagnostic triad of chest pain, sequential ECG changes and raised cardiac enzymes was present in only 24 very elderly patients and in 27 the diagnosis was not initially suspected. Presenting symptoms were often atypical and characteristic ECG changes could not be demonstrated in 25 patients. Very elderly patients had a higher mortality during the first few days in hospital, despite no greater incidence of cardiac failure and similar infarct size to the younger patients. Subsequent in-hospital mortality was similar in both groups. A higher index of suspicion of myocardial infarction in acutely ill very elderly patients should lead to earlier diagnosis, more appropriate management and may improve immediate prognosis.

Acute Myocardial Infarction in the Elderly

“…The relative rate of women was higher in “G,” with a male/female ratio of 2.1/1 vs 5.8/1. There was a higher proportion of painless infarction in “G” (13.7% vs 1.8%) similar to that described in other series, 2–4 of atypical pain (18.7% vs 2.5%), of pain at rest (86% vs 61%) and pain of long duration (more than 6 hours, 34.6% vs 19.8%) (P < .001 for all these parameters). A high incidence of painless infarction was observed in diabetic elderly patients (24.1% vs 5.7% in nondiabetics, P < .01) 5–6 .…”

Mitochondrial function in hypoxic ischemic injury and influence of aging

“…Aged individuals have demonstrated higher mortality after myocardial infarction despite similar infarct size to younger patients (Corsini et al , 2006; Day et al , 1987). It has been reported that ROS generated from mitochondria is significantly elevated in the heart with progression of age (Judge et al , 2005).…”

Illness Behavior in the Aged

“…As a result, many presenting symptoms typically associated with disease may be absent in the aged 24 . Certain older patients, for example, do not experience the pain associated with angina pectoris and thus may not seek care for an underlying heart condition 17,18,25,26 . Others do not feel early pain with acute appendicitis, frequently delay obtaining professional attention and increase the probability of their appendix perforating 27 .…”