II. Symptoms: Elderly Presentations of Acute Coronary Syndrome

  1. Most common presentations
    1. Dyspnea
    2. Syncope
    3. Generalized weakness
  2. Chest Pain is presenting symptom in only 24% of Acute Coronary Syndrome (ACS) age >75 years
    1. Contrast with 48% of younger adults who present with Chest Pain in ACS
  3. References
    1. Brieger (2004) Chest 126(2): 461-9 [PubMed]

III. Differential Diagnosis: Chest Pain

  1. See Chest Pain Causes
  2. Pulmonary Embolism
    1. See Pulmonary Embolism Pretest Probability (e.g. Wells Clinical Prediction Rule for PE, Revised Geneva Score)
    2. D-Dimer discriminatory values increase with age (See D-Dimer)
    3. Common presentations in older adults with Pulmonary Embolism
      1. Dyspnea
      2. Syncope
    4. Variable presentations
      1. Tachycardia is often absent
    5. Uncommon presentations in older adults with Pulmonary Embolism
      1. Pleuritic Chest Pain
      2. Hemoptysis
  3. Aortic Dissection
    1. Insidious onset of Chest Pain is more common in older adults than the sudden Chest Pain in younger adults
    2. Tearing, ripping or sharp Chest Pain is often absent in older adults
    3. Hypotension is a more common presentation in older adults

IV. Diagnostics

  1. Electrocardiogram (EKG)
    1. Non-diagnostic in up to 43% in over age 85 years with Myocardial Infarction
    2. Left Bundle Branch Block is present in 34% of older adults
    3. Old comparison Electrocardiogram is key

V. Management: Acute Coronary Syndrome

VI. References

  1. Spangler (2021) Crit Dec Emerg Med 35(2): 3-10

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