Clinical profile of acute myocardial infarction in elderly patients

 

J Satyanarayan Rao

 

Assistant Professor, Department of General Medicine, Kamineni Medical College and Research Centre, LB Ngar. Hyderabad, Telangana, INDIA.

Email: jinaga_satyanarayanrao@yahoo.com

 

Abstract              Background: Acute myocardial infarction is a common medical emergency. It is consequent to atherosclerotic narrowing of coronary arteries. The risk factors for coronary artery disease are hypertension, diabetes mellitus, smoking, low high density cholesterol[HDL] and high levels of low density cholesterol (LDL) Acute myocardial infarction in elderly is likely to present with 1) pain which is more likely to be termed “atypical” because the description differs from the classical one of substernal pressure with exertion. The chest pain is usually described as a substernal pressure sensation that is also perceived as squeezing, aching, burning, or even sharp. In some patients, the symptom is epigastric, with a feeling of indigestion or of fullness and gas. When pain is the presenting complaint, it may be different in character or location, and sometimes appears as an upper abdomen pain rather than a crushing or squeezing subesternal sensation.. Often they are unfit for interventions 2) Cardiovascular complications including cardiogenic shock, a trial fibrillation, and heart failure are more common in elderly 3) elderly patients arrive late for treatment late arrival for treatment/interventions Methodology: In this retrospective study 100 patients admitted with Acute myocardial infarction in ICCU during 2016/2017 in Kamineni Hospital, L.B. Nagar, Hyderabad were included They were divided into two groups Group A > 60yrs of either sex Group B < 60 years of either sex Their progress was followed from admission to discharge by going through case records. Results: In group A fewer patients underwent interventions like PTCA 27 patients, (54%) and 23 patients {46%} were managed conservatively. On the other hand in group B 33 Patients underwent PTCA and 17 patients were managed conservatively. In group A the male to female ratio was 1; 1.7 while in group B it was 4:1.In group A diabetes mellitus was present in 31% meanwhile 40 % in group B were patients of diabetes mellitus. Hypertension was present in 31 Patients [63%] In Group A but in group B 24 patients [68%] had hypertension. Atypical chest pain was more common in group A ie 19 patients[38%] compared to 16 patient [32%] in group B. Similarly in group A atypical symptoms like sweating was noted in 20 patients [40 %], breathlessness 17 patients[34%], nausea /vomiting 9 patients[15%] and giddiness in 4 patients[18%]. Typical chest pain was seen in 31 patients in group A and 34 pts in group B. It is by far the predominant symptom in acute myocardial infarction. They were less frequent in group B where in sweating was seen in 33 patients [66%], breathlessness 11 patients [22%], and nausea\vomiting 5 patients [10 %]. In group A 4 patients[8%] were brought within 3 hours, 16 patients [32%] within 3-12 hours,9 patients [18%] in 13-48 hours. In group B 9 patients, 18% were brought within 3-12 hours, 11 patients [ 22%] within 13-48 hours. Here more patients were brought within the first 12 hours. AALWMI 18% and ASWMI, 34% were more common in group A, while ALWMI 32% was more common in group B. Conclusion: Atypical features like sweating and breathlessness more common in elderly group although chest pain was predominant symptom in both groups, while nausea/ vomiting and palpitations was more common in elderly group.

Key Words: acute myocardial infarction.