J Korean Med Sci.  2009 Oct;24(5):789-794. 10.3346/jkms.2009.24.5.789.

Comparison of Factors Associated with Atypical Symptoms in Younger and Older Patients with Acute Coronary Syndromes

• Hwang SY
• Park EH
• Shin ES
• Jeong MH

• KMID: 1781995
• DOI: http://doi.org/10.3346/jkms.2009.24.5.789

Abstract

Patients with acute coronary syndromes (ACS) who are accompanied by atypical symptoms are frequently misdiagnosed and under-treated. This study was conducted to examine and compare the factors associated with atypical symptoms other than chest pain in younger (<70 yr) and older (> or =70 yr) patients with first-time ACS. Data were obtained from the electronic medical records of the patients (n=931) who were newly diagnosed as ACS and hospitalized from 2005 to 2006. The 7.8% (n=49) of the younger patients and 13.4% (n=41) of the older patients were found to have atypical symptoms. Older patients were more likely to complain of indigestion or abdominal discomfort (P=0.019), nausea and/or vomiting (P=0.040), and dyspnea (P<0.001), and less likely to have chest pain (P=0.007) and pains in the arm and shoulder (P=0.018). A logistic regression analysis showed that after adjustment made for the gender and ACS type, diabetes and hyperlipidemia significantly predicted atypical symptoms in the younger patients. In the older patients, the co-morbid conditions such as stroke or chronic obstructive pulmonary disease were positive predictors. Health care providers need to have an increased awareness of possible presence of ACS in younger persons with diabetes and older persons with chronic concomitant diseases when evaluating patients with no chest pain.

Keyword

Acute coronary syndrome; Symptoms

MeSH Terms

Abdominal Pain/etiology
Acute Coronary Syndrome/complications/*diagnosis
Adult
Age Factors
Aged
Aged, 80 and over
Diabetes Mellitus/etiology
Dyspnea/etiology
Female
Humans
Hyperlipidemias/etiology
Male
Middle Aged
Nausea/etiology
Odds Ratio
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive/etiology
Regression Analysis
Risk Factors
Stroke/etiology
Vomiting/etiology

Figure

• 

  Fig. 1 Type and frequency of chief atypical symptoms in patients with atypical presentation.

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