DIAGNOSTIC PITFALLS IN THE EMERGENCY WARD - EFFECT OF AGE IN MYOCARDIAL-INFARCTION

OBJECTIVE: To analyze the clinical signs and electrocardiographic and enzyme data in patients admitted to an emergency ward for myocardial i nfarction in order to highlight diagnostic pitfalls. PATIENTS AND METH ODS: Ail patients admitted to our emergency ward between October 1995 and October 1996 with elevated myoglobulin or creatinine phosphokinase (CPK) levels (n = 457 patients) were included in the study series. Pa tient files were randomly selected (n = 257 files) for review by an em ergency ward specialist and a cardiologist to identify cases of myocar dial infarction (n = 88 patients, mean age 73.4 +/- 15.2 years). Clini cal, electrical and enzyme data (including CPK-MB) were analyzed. RESU LTS: The patients had been referred for chest pain (69%), dyspnea (24% ) or another disorder (7%). Pain was located in the retrosternal area in 51%, in the lower chest in 19% and elsewhere in 30%. Delay between onset of pain and transfer to the emergency ward was 5 h 20 min +/- 6 h. Signs of left heart failure were observed in 50% of the patients. T he admission electrocardiogram showed complete criteria for myocardial infarction in 43% of the cases, incomplete criteria in 21% and was no n-contributive in 36%. Enzyme results were elevated in 78% of the case s at the first assay and in 98.2% at the second assay. Both typical ch est pain and ECC were observed in only 30% of the cases. Chest pain wa s present in 55% of the patients over 75 years of age and in 81% of th ose under 75 years (p = 0.007). CONCLUSION: A typical syndrome is obse rved in less than one-third of all patients with myocardial infarction admitted to emergency wards. The frequency of atypical presentations increases with age.