Acute myocardial infarction in elderly patients

We conducted a retrospective chart review on 50 patients under age 65 (average age 52.9 years) and 55 patients over 65 (average age 75.6 years). The older patients were much more likely to have atypical pain or no pain (38% vs 4%, P less than .0001). They were less likely to have electrocardiographic QRS changes (47% vs 72%), but more likely to have congestive heart failure (44% vs 16%, P less than .01). In 25% of the older patients, no diagnosis was made in the first 24 hours, as compared to 8% of the younger group. The increased mortality in the older group (16% vs 4%) approached statistical significance (P = .08). We conclude that the manifestations of acute myocardial infarction are more subtle in the elderly, with a higher proportion of atypical chest pain and nondiagnostic electrocardiograms, but the elderly are more likely to have congestive heart failure.