TY - JOUR
T1 - Acute Coronary Syndrome in Octogenarians
T2 - Expect the Unexpected
AU - Parnell, Samuel T.
AU - Smith, Austin T.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/2
Y1 - 2018/2
N2 - Background: Ischemic heart disease is the leading cause of death in the United States and the world. Advanced age is the strongest risk factor for ischemic heart disease and the best independent predictor for poor outcomes after acute coronary syndrome (ACS). Elderly patients are at high risk for ACS, and numerous studies have shown that octogenarians in particular experience increased morbidity and mortality compared to younger patients. Case Report: We describe a case of an 83-year-old woman who presented to the emergency department with a chief complaint of sore throat and was found to have a non-ST elevation myocardial infarction (NSTEMI) and was treated successfully with primary coronary intervention (PCI). Why Should an Emergency Physician Be Aware of This?: Chest pain is a common presenting symptom for ACS, but elderly patients with MI are more likely to present with other chief complaints. Only 40% of patients in the National Registry of Myocardial Infarction database ≥ 85 years of age had chest pain on initial presentation. Recent studies comparing invasive therapy (PCI or coronary artery bypass graft) with optimal medical therapy for patients > 75 years of age diagnosed with NSTEMI have reported a reduced risk of death and major cardiac events with invasive therapy. Emergency physicians should have a high level of suspicion for ACS in octogenarians, even in those presenting without chest pain. Timely diagnosis and management can improve morbidity and mortality in these patients.
AB - Background: Ischemic heart disease is the leading cause of death in the United States and the world. Advanced age is the strongest risk factor for ischemic heart disease and the best independent predictor for poor outcomes after acute coronary syndrome (ACS). Elderly patients are at high risk for ACS, and numerous studies have shown that octogenarians in particular experience increased morbidity and mortality compared to younger patients. Case Report: We describe a case of an 83-year-old woman who presented to the emergency department with a chief complaint of sore throat and was found to have a non-ST elevation myocardial infarction (NSTEMI) and was treated successfully with primary coronary intervention (PCI). Why Should an Emergency Physician Be Aware of This?: Chest pain is a common presenting symptom for ACS, but elderly patients with MI are more likely to present with other chief complaints. Only 40% of patients in the National Registry of Myocardial Infarction database ≥ 85 years of age had chest pain on initial presentation. Recent studies comparing invasive therapy (PCI or coronary artery bypass graft) with optimal medical therapy for patients > 75 years of age diagnosed with NSTEMI have reported a reduced risk of death and major cardiac events with invasive therapy. Emergency physicians should have a high level of suspicion for ACS in octogenarians, even in those presenting without chest pain. Timely diagnosis and management can improve morbidity and mortality in these patients.
KW - ACS
KW - acute coronary syndrome
KW - chest pain equivalent
KW - coronary artery disease
KW - geriatric emergencies
KW - myocardial infarction
KW - non-ST elevation myocardial infarction
KW - octogenarians
KW - silent myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85034733980&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034733980&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2017.10.013
DO - 10.1016/j.jemermed.2017.10.013
M3 - Article
C2 - 29174752
AN - SCOPUS:85034733980
SN - 0736-4679
VL - 54
SP - e27-e30
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 2
ER -