Atypical presentation of acute myocardial infarction in 3 age groups

OBJECTIVE: The purpose of this study was to compare the clinical manifestations of first-time acute myocardial infarction (AMI) in 3 age groups of men and women who presented to the emergency departments of 3 acute tertiary care hospitals. DESIGN: An exploratory, descriptive design was used, and there were 2 phases to the project. Phase 1 was a retrospective chart audit of a systematic random sample of patient charts, and phase 2 included a structured interview of a prospective random sample of emergency and intensive care unit nurses and physicians. The data were collected hy using a chart audit tool and a semistructured interview, respec tively. SETTING: The study took place at a western Canada university affiliated with acute tertiary care centres. SAMPLE: A systematic random sample of 153 (105 men and 48 women) patient charts were audited from the health records departments of 3 acute care hospitals. All of the patients had experienced a first-time AMI. In addition, a random sample of emergency/intensive care unit nurses (n = 60) and physicians (n = 18) was interviewed. RESULTS: The results indicate that a statistically significant number of the oldest (75 years or older) male patients present with atypical manifestations of AMI compared with the men in the younger age groups (P = .005). The same trend was not noted for female patients. The results of the study are limited with respect to the small number of women in each age category. Caution must therefore be exercised in generalizing the results to the target population of women with AMI. The atypical manifestations are described. The results of the interviews revealed that many clinicians do not look for different clinical manifestations when assessing older patients. CONLUSIONS: It is essential that nurses and physicians accurately assess patients with AMI, especially patients in the older age groups who may be presenting atypically. It is also important that professional and nonprofessional public health education initiatives include information regarding both typical and atypical presentation of AMI, particularly in the older patient.