RT Book, Section
A1 Paruthi, Christina
A1 Paniagua, Miguel
A2 Williams, Brie A.
A2 Chang, Anna
A2 Ahalt, Cyrus
A2 Chen, Helen
A2 Conant, Rebecca
A2 Landefeld, C. Seth
A2 Ritchie, Christine
A2 Yukawa, Michi
SR Print(0)
ID 1100069909
T1 Addressing Chest Pain in Older Adults
T2 Current Diagnosis & Treatment: Geriatrics, 2e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179208-0
LK accessmedicine.mhmedical.com/content.aspx?aid=1100069909
RD 2024/04/19
AB Older  patients  are  more  likely  than  younger  patients  to  have  a  cardiac  event  in  the  absence  of  chest  pain  or  present  to  medical  care  with  an  atypical  clinical  presentation  of  chest  pain.  Fewer  than  half  of  patients  whose  ultimate  diagnosis  is  acute  myocardial  infarction  (MI)  are  admitted  for  acute  MI.  The  National  Registry  of  Myocardial  Infarction  (NRMI)  showed  that  only  40%  of  older  patients’  chief  complaints  were  chest  pain,  compared  to  77%  of  patients  presenting  with  MI  age  65  years  or  younger.  Patients  may  present  with  nausea,  fatigue,  or  delirium.  The  lack  of  typical  symptoms  can  lead  to  treatment  delay  and  increased  morbidity  and  mortality  in  the  older  patient  population  (see  Chapter  7,  “Atypical  Presentations  of  Illness  in  Older  Adults”).  For  adults  age  65  years  or  older,  ischemic  heart  disease  accounts  for  81%  of  mortality,  and  should  therefore  be  the  first  diagnosis  considered  when  an  older  adult  presents  for  medical  care  with  chest  pain.  However,  chest  pain  in  older  patients  can  also  be  noncardiac  in  origin  or  of  a  cardiac  etiology  other  than  coronary  artery  disease.  Noncardiac  origins  of  chest  pain  include  pulmonary  and  esophageal.  Although  not  all  causes  of  chest  pain  in  the  older  adult  will  lead  to  fatal  events,  timely  diagnosis  based  on  a  history  of  associated  factors  and  a  targeted  physical  exam  can  improve  an  older  patient’s  health  outcomes  in  the  short-term,  as  well  as  longer-term  quality  of  life,  functionality,  and  health  outcomes.  It  is  therefore  essential  that  clinicians  take  a  thorough  history,  perform  a  targeted  physical  exam,  and  have  a  high  level  of  suspicion  to  make  the  correct  diagnosis  in  a  timely  manner.