Changing Presentation of Myocardial Infarction With Increasing Old Age

Bayer, Antony James; Chadha, J. S.; Farag, Rania H.; Pathy, M. S.

doi:10.1111/j.1532-5415.1986.tb04221.x

Cited by 231 publications

(76 citation statements)

References 12 publications

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“…24 The last one is very likely exemplified in that the elderly who did not describe chest pain also did not describe sweating, nausea, and vomiting. 1 The older the population, the more frequently the symptoms of heart failure exacerbation were described in the acute phase of MI. 6 Typical symptoms of chronic heart failure exacerbation were often accompanied by mental disorders, dizziness, presyncope, and syncope.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile of acute myocardial infarction in elderly patients

Bhatia

Naik

2013

Journal of Cardiovascular Disease Research

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a b s t r a c tContext: The aim of study was to determine the difference in presentation, risk factors, complications, management and outcome of elderly and young patients with acute myocardial infarction (AMI). Settings and design: Tertiary care center; prospective observational study. Materials and method: The study included 200 consecutive patients with AMI admitted in the ICCU, in a tertiary care center in West India. The group I consisted of 107 patients aged equal to or above 65 years and the group II consisted of 93 patients aged below 65 years. Statistical analysis: Two tailed student's t test and Chi-square statistics (Fisher's test) for P value. Results: The male female ratio was 1.27:1 and 3.43:1 in group I and group II respectively. Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (40.18% versus 15.05%; P < 0.05. Risk factors like hypertension, dyslipidemia and diabetes were equally present in both groups but obesity, smoking and family history of coronary artery disease was more prevalent in younger age group (P < 0.05). The elderly were significantly less frequently revascularized (P < 0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (P < 0.05). The elderly were more likely to have complications of cardiac failure (P < 0.05) and arrhythmias especially atrio-ventricular (AV) blocks. The elderly were also less likely to receive betablockers (P < 0.05). In-hospital mortality was higher in the elderly (P < 0.001). Conclusion: We conclude that the manifestations of AMI are more subtle in the elderly, with different risk factors.

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Section: Discussionmentioning

confidence: 99%

Clinical profile of acute myocardial infarction in elderly patients

Bhatia

Naik

2013

Journal of Cardiovascular Disease Research

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“…anticonvulsants, theophylline, and digoxin). Occasionally, patients with acute myocardial infarction can also present with delirium without chest pain; 69,141 hence, a 12-lead electrocardiogram and cardiac biomarkers should be considered, but their diagnostic yield in ED patients with delirium remains unknown. A lumbar puncture, though not routinely performed, should be strongly considered if there is a clinical suspicion for meningitis or encephalitis or if the patient has a fever or leukocytosis without an obvious source.…”

Section: Laboratory Testingmentioning

confidence: 99%

“…Other precipitants for delirium include electrolyte abnormalities such as hyponatremia, hypernatremia, hypercalcemia, and hypocalcemia, 58,64 organ failure, 58,64 Wernicke's encephalopathy, thyroid dysfunction, 65 central nervous system insults such as cerebrovascular accidents, intracerebral hemorrhage, epidural and subdural hematomas, and subarachnoid hemorrhage, 52,53,60,63 ethanol and benzodiazepine withdrawal, [66][67][68] dehydration, 41 and cardiovascular illnesses such as congestive heart failure, 53,54 and acute myocardial infarction. 69 Poorly controlled somatic pain (i.e. extremity fracture patients) can also precipitate delirium.…”

Section: Precipitating Factors For Acute Brain Dysfunctionmentioning

confidence: 99%

Altered Mental Status in Older Emergency Department Patients

Wilber

2006

Emergency Medicine Clinics of North America

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SynopsisAltered mental status is a common chief complaint among older emergency department (ED) patients. Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. These forms of acute brain dysfunction are commonly precipitated by an underlying medical illness that can be potentially life-threatening and are associated with a multitude of adverse outcomes. Though stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute brain dysfunction, the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple etiologies may exist concurrently. Keywordsdelirium; coma; stupor emergency department; epidemiology; diagnosis; management IntroductionAltered mental status is a common chief complaint among older emergency department (ED) patients. Despite the frequency of this complaint, the term "altered mental status" is vague and has several synonyms such as confusion, not acting right, altered behavior, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behavior, inattention, and hallucination. 1 Such lack of standardized terminology not only hinders the assessment and appropriate management of patients with altered mental status, but also the advancement of knowledge through research.Altered mental status has varying time courses and degrees of severity. Acute changes in mental status are usually secondary to delirium, stupor, and coma, which are forms of acute brain dysfunction. These changes occur over a period of hours or days and are usually © 2012 Elsevier Inc. All rights reserved. Correspondence to: Jin H. Han, jin.h.han@vanderbilt.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript precipitated by an underlying medical illness that is potentially life threatening. Chronic alterations in mental status (e.g. dementia) occur over a period of months and years and are less likely to be precipitated by a life-threatening illness. 2 For these reasons, acute changes in mental status will be the focus of this review. Altered mental status is rarely caused by psychiatric illnesses such as depression or schizophrenia, and in elder patients, these should be diagnoses of exclusion. Acute brain dysfunction (delirium, stupor, and coma) and their underlying etiology should be ruled out prior to considering any psychiatric d...

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“…Classification of patients with increased CK activity is shown in the table. CK:AST ratios in those patients with an increased CK activity on days 1, 2, and 3 are shown in fig 1. The CK:AST ratio was higher on all days (p < 0-01) in "fallers" than in "non-fallers".…”

Section: Discussionmentioning

confidence: 92%

Is serum creatine kinase:aspartate aminotransferase ratio useful for diagnosing acute myocardial infarction in elderly patients?

Swain¹,

Gama²

1993

Journal of Clinical Pathology

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have an AMI. The overlap, however, between these groups was large. Conclusions: These results did not allow discrimination to be made between myocardial and skeletal sources for increased CK activity. The CK:AST ratio is, therefore, of limited use when applied to the diagnosis of AMI in elderly patients. Clinical evaluation rather than the pattern of enzyme change is more likely to determine the cause of increased CK activity. (7 Clin Pathol 1993;46:264-266)

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Changing Presentation of Myocardial Infarction With Increasing Old Age

Cited by 231 publications

References 12 publications

Clinical profile of acute myocardial infarction in elderly patients

Clinical profile of acute myocardial infarction in elderly patients

Altered Mental Status in Older Emergency Department Patients

Is serum creatine kinase:aspartate aminotransferase ratio useful for diagnosing acute myocardial infarction in elderly patients?

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