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[The unrecognized myocardial infarct in the aged--contribution to prognosis]
Insights
Many myocardial infarctions in elderly patients go undiagnosed, with 80% of cardiac scars missed in a clinical-autoptical study. This suggests a more favorable prognosis for heart attacks in older adults than previously thought.
Area of Science:
- Cardiology
- Geriatric Medicine
- Pathology
Context:
- Clinical observations often dictate the perceived prognosis of myocardial infarction in the elderly.
- Atypical symptoms and hospital admission rates may lead to underdiagnosis in older populations.
Purpose:
- To estimate the percentage of undiagnosed myocardial infarctions in elderly individuals through a clinical-autoptical analysis.
Summary:
- A study of 124 deceased individuals (mean age 80) with transmural myocardial scars found 80% were previously undiagnosed.
- Electrocardiograms showed definite scars in only 35%, and angina pectoris was reported by 22%, primarily in patients with known heart attacks.
- Poor recall and communication in the elderly partially explain these diagnostic gaps.
Impact:
- Findings suggest the overall prognosis of acute myocardial infarction in the elderly may be more favorable than clinical data indicate.
- Highlights the significant rate of silent myocardial infarction in advanced age.
- Underscores the need for improved diagnostic strategies for heart attacks in geriatric populations.
Abstract:
The poor prognosis of myocardial infarction in old people is based almost completely upon clinical observations. But in the case of patients of advancing years it seems likely that the percentage of undiagnosed infarctions-whether due to atypical symptoms or to the fact that the patient is not admitted to hospital-is considerable. To estimate the level of this percentage a clinical-autoptical analysis of 124 decreased with transmural myocardial scars was carried out (mean age of death: 80 years). This reveals that 80% of all myocardials scars had not hitherto been diagnosed. Only 35% of the electrocardiograms showed definite scars, mostly in the case of patients with known myocardial infarction. 22% of deceased had complained about angina pectoris, again mostly patients with known myocardial infarction. In comparison with other studies of people in the same age group, the results are not surprising. This is only explained in part by old people's poor powers of recollection and their limited ability to communicate. These results indicate that the over all prognosis of acute myocardial infarction in old people, which often does not occur in hospital without being diagnosed should be viewed in a more favourable light than clinical results would suggest.