Gender and age differences in chief complaints of acute myocardial infarction (Worcester heart attack study)

Milner, Kerry A.; Vaccarino, Viola; Arnold, Amy; Funk, Marjorie; Goldberg, Robert J.

doi:10.1016/j.amjcard.2003.11.028

Cited by 107 publications

(81 citation statements)

References 6 publications

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“…22) • Gender difference in AMI symptoms -females complain of AMI symptoms such as chest pain even when AMI is absent. 17,19,[23][24][25] • Gender bias -women or minorities tend to be treated less aggressively by physicians. 5,26) • Gender difference in socioeconomic status -women may have a lower economic status, and are more likely to hesitate undergoing an expensive treatment such as PTCA.…”

Section: Discussionmentioning

confidence: 99%

Age-related Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction in Japan Tokai Acute Myocardial Infarction Study: TAMIS

et al. 2005

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SUMMARYIt is of concern that women are more likely to undergo fewer diagnostic tests and receive less treatment for acute myocardial infarction (AMI) than men. However, it is still unclear whether gender differences exist according to age groups. Therefore, we studied the influence of gender on the delivery of cardiac management according to two age groups (< 65, 65) in Japan. Data from the Tokai Acute Myocardial Infarction Study (TAMIS) sample were used. This is a retrospective study of all consecutive patients admitted to the 13 acute care hospitals in the Tokai region of Japan, which includes Aichi and Shizuoka Prefectures, with a diagnosis of AMI from 1995 to 1997. A total of 143 younger women, 822 younger men, 391 older women, and 611 older men were included. Information concerning patient demographics, in-hospital course, comorbid conditions, electrocardiography (ECG), ultrasound-echocardiography (UCG), treadmill test (TMT), coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), intra-aortic balloon pump (IABP), mechanical ventilation, and in-hospital or discharge medication (thrombolytics, vasopressors, aspirin, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, nitrates) were collected. Among the young, after controlling for these baseline variables, women were significantly less likely to undergo PTCA compared to men (OR, 0.54, 95%CI,. After controlling for these baseline variables, only lipid-lowering therapy tended to be more frequent in women than in men among the elderly (OR, 2.79, 95%CI, 1.47-2.58). The findings suggest that younger women with AMI are less likely than younger men to undergo PTCA, and that older women with AMI are more likely to receive lipid-lowering therapy. (Int Heart J 2005; 46: 939-948)

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Section: Discussionmentioning

confidence: 99%

Age-related Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction in Japan Tokai Acute Myocardial Infarction Study: TAMIS

et al. 2005

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“…[1][2][3][4] Because the number of aged AMI patients who present without chest pain is growing, 5,6) it would be valuable to determine what in-hospital cardiac management such patients receive and to see whether the in-hospital outcomes for these patients are disappointing. Despite the importance of this subject, the impact of the lack of chest pain among AMI patients on in-hospital outcomes has not been studied widely, particularly in Japan.…”

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confidence: 99%

Japanese Patients With Acute Myocardial Infarction Who Present Without Chest Pain A High-risk Group

et al. 2006

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SUMMARYPrevious studies have suggested that patients with acute myocardial infarction (AMI) who presented without chest pain had an unfavorable prognosis due to undertreatment. Despite this, few studies have been conducted on the topic, particularly in Japan. The present analysis aimed at determining whether Japanese AMI patients without chest pain are undertreated and experience higher mortality during hospitalization. Data from the Tokai Acute Myocardial Infarction Study II sample were used, which is a prospective study of all consecutive patients admitted to the 15 acute care hospitals in the Tokai region with the diagnosis of AMI from 2001 to 2003. Data on baseline and procedural characteristics and hospital outcome were collected. Differences in the baseline and procedural characteristics and clinical outcomes between patients presenting with and without chest pain were assessed. We evaluated a total of 1769 patients who presented with chest pain and 452 who did not. The patients with AMI in the absence of chest pain were older and were more likely to have worse clinical conditions than those with chest pain. They were more likely to be undertreated, although the probability of vasopressor use was higher. The patients without chest pain had a significantly higher in-hospital mortality rate than those with chest pain. According to multivariate analysis, however, chest pain was not identified as an independent predictor of in-hospital death. The results suggest that the higher in-hospital mortality rate among Japanese AMI patients without chest pain could be accounted for by differences in clinical conditions. (Int Heart J 2006; 47: 483-490)

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“…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%

“…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%

“…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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Gender and age differences in chief complaints of acute myocardial infarction (Worcester heart attack study)

Cited by 107 publications

References 6 publications

Age-related Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction in Japan Tokai Acute Myocardial Infarction Study: TAMIS

Age-related Differences in the Delivery of Cardiac Management to Women Versus Men With Acute Myocardial Infarction in Japan Tokai Acute Myocardial Infarction Study: TAMIS

Japanese Patients With Acute Myocardial Infarction Who Present Without Chest Pain A High-risk Group

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

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