Clinical Manifestation of Acute Myocardial Infarction in Elderly Patients

Md Liakat Hossain, Azm Ahsan Ullah, Mohammad Mizanur Rahman, Md Haidar Ali, Rashedul Hasan, Muhammad Nafees Hussain Amit, Kshitish Chandra Talukder
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Abstract

Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. Yet, a large number of patients may have atypical or no symptoms. As an indication of a cardiac problem, resulting in a delay in seeking medical care the absence of typical chest pain and the vagueness of symptoms might not be recognized. The absence of typical chest pain and the vagueness of symptoms might not be recognized. This cross sectional observational study was carried out among 50 patients >60 years of either sex with acute myocardial infarction in the Department of Medicine and CCU of Dhaka Medical College Hospital, Dhaka, from January 2018 to July 2018. Then consent was taken. History taking and physical examination were done in a predesigned data collection sheet. Then required investigation like ECG, cardiac enzymes and relevant laboratory investigations was done. After collecting all available information statistical analysis was done using SPSS for windows version 20. Result was expressed as frequency, percentage, mean (±SD), range, p-value. Among the 50 patients diagnosed as having AMI, 14 (28%) patients presented with atypical presentation to the hospital. Atypically presenting AMI Patients were mostly ae group 60-69 years (50%). Among all patients 29 (58%) were male and 21(42%) were female. 14 (28%) patients had no complaints of chest pain, out of which, dyspnea and epigastric pain (28.6%) are the commonest. Atypical presentation is found in 38.1% of female elderly patients and 20.7% of male patients (p=0.002). Commonest risk factor, found in this study was hypertension (66%) of the patients included in the study. Next common was Diabetes Mellitus (64%), hypercholesterolemia (56%) and smoking (28%). 13 Patients with Diabetes presented with atypical symptoms among atypical group (p=0.008). Most of the patients with atypical symptoms (78%) presented lately more than 12 hours compared to patients with typical symptom. Mortality rate was higher among the patient presented with atypical symptoms (42.3%) than among the patients presented with typical chest pain (27.7%). 28% patient with atypical chest pain was found to have inferior MI and mortality was highest among those with inferior MI and atypical symptoms. This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like dyspnea, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly for successful and immediate treatment. Accurate diagnosis of ACS could reduce hospital mortality and morbidity. Bangladesh Med J. 2022 May; 51(2): 13-20
老年急性心肌梗死的临床表现
心肌梗死是导致老年患者死亡和发病的最常见原因之一。此外,除了胸痛之外,它还以广泛的临床表现而闻名。然而,大量患者可能有非典型症状或无症状。作为心脏问题的指征,没有典型的胸痛和症状模糊可能无法识别,从而导致寻求医疗护理的延误。没有典型的胸痛和症状模糊可能无法识别。本横断面观察性研究于2018年1月至2018年7月在达卡医学院医院内科和CCU的50例>60岁的急性心肌梗死患者中进行。然后同意了。病史记录和体格检查在预先设计的资料收集表中完成。然后进行心电图、心酶及相关实验室检查。收集所有可用信息后,使用SPSS for windows version 20进行统计分析。结果以频率、百分比、平均值(±SD)、极差、p值表示。在50例确诊为急性心肌梗死的患者中,14例(28%)患者就诊时表现不典型。非典型表现AMI患者多为60 ~ 69岁年龄组(50%)。所有患者中男性29例(58%),女性21例(42%)。14例(28%)患者无胸痛主诉,其中呼吸困难和上腹痛最为常见(28.6%)。38.1%的老年女性患者和20.7%的老年男性患者表现不典型(p=0.002)。本研究中最常见的危险因素是高血压(66%)。其次是糖尿病(64%)、高胆固醇血症(56%)和吸烟(28%)。不典型组有13例糖尿病患者出现不典型症状(p=0.008)。与典型症状患者相比,大多数非典型症状患者(78%)出现时间超过12小时。非典型胸痛患者的死亡率(42.3%)高于典型胸痛患者(27.7%)。28%的非典型胸痛患者发现有下壁心肌梗死,在下壁心肌梗死和非典型症状的患者中死亡率最高。这项研究表明,尽管胸痛是老年AMI患者最常见的表现,但也发现他们有非典型的表现,如呼吸困难、呕吐、出汗和胃脘痛。这意味着需要检查医生仔细识别急性心肌梗死在老年人成功和及时的治疗。准确诊断ACS可降低住院死亡率和发病率。孟加拉国医学杂志;2022年5月;51 (2): 13-20
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