Emergency Nursing Recognition of Atypical Acute Myocardial Infarction: Associations With Functional Status and Level...

Emergency nurses play a central role in the early recognition of acute myocardial infarction. Although chest pain is commonly considered the hallmark symptom, a considerable proportion of patients-particularly older adults and those with functional or cognitive impairment-present without chest-related symptoms. These atypical presentations can make early identification during triage more difficult and may contribute to delayed diagnosis. This study examined whether functional status and level of consciousness are associated with atypical symptom presentation in patients with acute myocardial infarction.

We conducted a retrospective cohort study using electronic health record data from a regional teaching hospital in Taiwan. Adult patients aged 40 years or older diagnosed as having acute myocardial infarction between 2016 and 2023 were included. Symptom presentation was classified as typical (chest pain or chest tightness) or atypical (absence of chest-related symptoms). Patient characteristics, activities of daily living, Glasgow coma scale, and clinical variables were compared. Multivariable logistic regression was used to identify factors associated with atypical presentation.

Among 1076 patients, 19.0% presented without chest-related symptoms. Patients with atypical presentations were older and had lower body mass index, greater dependence in activities of daily living, and lower Glasgow coma scale scores. In multivariable analysis, reduced level of consciousness (odds ratio, 4.93; 95% CI, 2.41-10.05; P<.001) and greater functional dependence (odds ratio, 1.10; 95% CI, 1.06-1.15; P<.001) were independently associated with atypical presentation.

Atypical presentation was common, particularly among patients with functional or cognitive impairment. These findings suggest that relying on chest-related symptoms alone may not be sufficient during triage. Routine nursing assessments, including activities of daily living and Glasgow coma scale, may provide useful cues for identifying patients at a higher risk of atypical acute myocardial infarction presentation.