RESUMEN
The clinical features and outcome were determined for 100 consecutive patients aged 65 years or older with a history of diabetes mellitus who presented to hospital with acute myocardial infarction. Each case was compared with an age- and sex-matched nondiabetic control also admitted to hospital with acute myocardial infarction. Chest pain was equally common in both groups and was the main presenting symptom. Cardiac failure was a more frequent accompaniment in the diabetics, despite the lack of evidence for greater infarct size in this group. The outcome was worst for female diabetics, of whom 46% died. Contrary to popular teaching, painless myocardial infarction is not a specific feature of elderly diabetics.
Asunto(s)
Complicaciones de la Diabetes , Infarto del Miocardio/complicaciones , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Angina de Pecho/complicaciones , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Infarto del Miocardio/mortalidad , PronósticoRESUMEN
The diagnostic features and outcome of acute myocardial infarction in 100 very elderly (aged 85 years or more) hospitalized patients are reviewed and compared with those in a group of younger elderly (aged 65-84 years). The diagnostic triad of chest pain, sequential ECG changes and raised cardiac enzymes was present in only 24 very elderly patients and in 27 the diagnosis was not initially suspected. Presenting symptoms were often atypical and characteristic ECG changes could not be demonstrated in 25 patients. Very elderly patients had a higher mortality during the first few days in hospital, despite no greater incidence of cardiac failure and similar infarct size to the younger patients. Subsequent in-hospital mortality was similar in both groups. A higher index of suspicion of myocardial infarction in acutely ill very elderly patients should lead to earlier diagnosis, more appropriate management and may improve immediate prognosis.
Asunto(s)
Infarto del Miocardio/diagnóstico , Anciano , Anciano de 80 o más Años , Electrocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Tiempo de Internación , Masculino , Infarto del Miocardio/mortalidad , PronósticoRESUMEN
The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the sole presenting symptom. Shortness of breath, although the most frequently reported symptom in the absence of chest pain, was equally common at all ages. Thus, in patients aged 85 years or over, "atypical" presentation of myocardial infarction became the rule, and in the very old the clinician must be prepared to screen for the diagnosis in most acutely ill patients.