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[Myocardial infarct in the admissions and emergency service: a particular entity or predominant atypia?...]
Insights
Diagnosing myocardial infarction (MI) in emergency departments requires attention, as many patients lack typical chest pain, especially older individuals. Wider consideration of MI diagnosis is crucial in emergency settings.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Myocardial infarction (MI) diagnosis in emergency departments (EDs) is challenging due to varied symptom presentation.
- A significant proportion of ED patients with MI do not exhibit typical chest pain, with some presenting with no pain or even unrecognized symptoms.
Discussion:
- The frequency of atypical MI presentations, including absence of pain, increases with age.
- ED patients with MI represent a unique cohort often not receiving pre-hospital emergency care.
- MI constitutes a small fraction of ED diagnoses (0.4%) but a substantial referral source (23%) to cardiac intensive care units.
Key Insights:
- Only 61% of emergency ward patients with MI present with typical chest pain.
- Atypical presentations, including no pain (7%) and asymptomatic cases (1.1%), are prevalent.
- Age is a significant factor, with older patients more likely to have atypical MI symptoms.
Outlook:
- Enhanced vigilance for MI diagnosis in EDs is recommended, particularly for the elderly population.
- Broader diagnostic consideration of MI in emergency settings can improve patient outcomes.
- Further research into early detection strategies for atypical MI presentations in diverse age groups is warranted.
Abstract:
The diagnosis of myocardial infarction in patients seen in the emergency ward warrants special attention. As demonstrated by Leconte et al. in this issue of La Presse Médicale, only 61% of them have typical chest pain. Nearly 7% have no pain and even 1.1% have no recognizable symptoms of myocardial infarction at all! These authors also observed that the frequency of atypical presentations increases with age. Emergency ward patients with myocardial infarction are indeed a particular population simply due to the mere fact that their symptoms did not lead to pre-hospital care by a mobile emergency unit. Considering the flow of patients in the emergency ward (myocardial infarction accounts for only 0.4% of diagnoses) and the percentage of patients in cardiac intensive care units referred from the emergency ward (23% in our unit) it is clear that special attention should be given to entertaining the diagnosis of myocardial infarction more widely in the emergency ward, particularly in older patients.