Presentation is often pain free in elderly patients

BMJ 1994;308:1159 (30 April)

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Presentation is often pain free in elderly patients

EDITOR,--Regrettably, guidelines for timely administration ofthrombolytic agents in suspected myocardial infarction¹ failto take cognisance of the fact that about a third of elderlypatients with this diagnosis have a pain free presentation,characterised by sudden onset breathlessness, mental confusion,or collapse.² The time of onset of these symptoms, accuratelyidentified, is equivalent to time of onset of chest pain forthe purposes of thrombolytic treatment if the diagnosis is subsequentlyconfirmed by electrocardiography. The indications for treatmentwould be similar to those already in use for patients presentingwith chest pain.¹

O M P Jolobe

Consultant geriatrician, Department of Medicine for the Elderly, Tameside General Hospital, Ashton under Lyne OL6 9RW.

Weston CFM, Penny WJ, Julian DG. Guidelines for the early management of patients with myocardial infarction. BMJ 1994;308:767-71. (19 March.) [Free Full Text]
Bayer AG, Chandra JS, Farag RR, Pathy MSJ. Changing presentation of myocardial infarction with increasing age. J Am Geriatr Soc 1986;34:263-6. [Medline]

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Guidelines for the early management of patients with myocardial infarction: C F M Weston, W J Penny, and D G Julian
BMJ 1994 308: 767-771. [Extract] [Full Text]