Unrecognized Q-wave myocardial infarction in patients older than 64 years in a long-term health-care facility

Influence of age on pain perception in acute myocardial ischemia: A possible cause for delayed treatment in elderly patients

“…Elderly patients have a longer lag time in seeking medical help compared to younger patients [1][2][3] and it has been speculated that this could be due to an impaired pain perception in elderly patients [7][8][9][10][11][12][13].…”

“…Several studies have demonstrated the atypical features and wide variety of symptoms in elderly patients with acute myocardial infarction [7][8][9]. A higher prevalence of diabetes and multivessel diseases, leading to ischemic preconditioning through repetitive episodes of ischemia or more collateral flow, were suggested as possible mechanisms.…”

Chronic Chagas’ Heart Disease in the Elderly: A Clinicopathologic Study

“…Moreover, intraventricular conduction defects are found at higher fre quency than in other types of cardiomyopathy [16]. Nevertheless, ventricular premature contractions, left anterior hemiblock, atrial fibrillation and pathological Q waves are com monly observed in the ECG of nonchagasic elderly patients [ 13,[22][23][24]. In contrast, right bundle block alone and associated with left anterior hemiblock is more frequent in elderly patients with Chagas' disease than in the gen eral elderly population [7], The ECG tracings recorded in this study showed the same alter ations, and the same frequency of occurrence as those detected in middle-aged patients with chronic Chagas' heart disease.…”

Therapy of Older People for Myocardial Infarction

“…The prevalence was 0.5% at age 50 years but exceeded 5% at age 75 years, and the incidence was almost zero up to age 40, then increased steeply to more than 300 cases per 100,000 persons at age 60 and decreased with age after 65 years. Other studies 29–34 have also reported a high prevalence of silent or unrecognized myocardial infarctions in older persons, with some studies reporting that up to 60% of myocardial infarctions may be unrecognized or silent in the very old. In regard to risk factors for CAD, most of the studies have not detected a significant difference between patients with and without recognized myocardial infarctions although some studies have found that patients with unrecognized myocardial infarctions are more likely to be hypertensive, to have diabetes, and to smoke cigarettes 28,35,36 .…”