UMEM Educational Pearls

Category: Cardiology

Title: Atypical presentations of ACS in elderly

Keywords: elderly, geriatric, chest pain, acute coronary syndrome (PubMed Search)

Posted: 11/11/2007 by Amal Mattu, MD (Updated: 7/10/2020)
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Atypical presentations of ACS in the elderly are common.
Only 40% of patients > 85yo present with chest pain. Dyspnea is the most common presenting complaint in these patients. Other atypical presentations include isolated nausea, vomiting, diaphoresis, or syncope.

The presence of an atypical presentation is not reassuring in terms of prognosis. Patients presenting atypically have a 3-fold higher in-hospital mortality (13% vs. 4%). This doesn't even include the patients that are inadvertently discharged home because of failure to diagnose ACS.