Recognition of atypical myocardial infarctions in the older adult presenting to the emergency department

TITLE: Recognition of Atypical Myocardial Infarctions in the Older Adult Presenting to the Emergency Department AUTHOR: Judith A. Nordblom APPROVED: lV Reducing the risk of delayed treatment to patients in the emergency department is a constant challenge. Recognizing atypical presentations of myocardial infarctions is a clinical challenge in the emergency department. Without the presence of chest pain, the staff is not cued to suspect a myocardial infarction, consequently delaying the onset of diagnostic interventions. To increase the care efficiency for patients with atypical symptoms of myocardial infarction, this study aimed to establish a pattern of presentation signs and symptoms, sample characteristics, risk factors and previous medical events to determine whether or not these patients have had a myocardial infarction. The present study demonstrated that 38.6% (CI of35-42%) ofpatients diagnosed with a myocardial infarction presented to the emergency department with atypical signs and symptoms that would be considered unrecognized. Previous studies have found between 24-40% subjects had unrecognized myocardial infarctions. The sample consisted of 316 subjects (171-54% with myocardial infarction) taken from the census of two hospital emergency departments, one urban setting and one community setting. The inclusion criteria were subjects who presented to the emergency department with dizziness or shortness of breath or were diagnosed with a myocardial infarction. The study was a retrospective descriptive chart review between April 2004 and August 2006.