UMEM Educational Pearls

Category: Geriatrics

Title: MI in the elderly

Keywords: acute MI, MI, myocardial infarction, geriatrics, elderly, acute coronary syndrome (PubMed Search)

Posted: 8/21/2011 by Amal Mattu, MD
Click here to contact Amal Mattu, MD

Elderly patients are high risk for missed MI because of atypical presentations. Though this seems to be relatively common knowledge, it is not always remembered. So here's a reminder....

  • Elderly patients present with chest pain during their MI only ~ 50% of the time
  • Dyspnea is the most common anginal equivalent (alternative complaint). Other common anginal equivalents are syncope, nausea, vomiting, or diaphoresis
  • The ECG in elderly patients with AMI is more frequently non-diagnostic. Only 40% of the time do they present with a STEMI, and when they do have ST elevation it may be less elevation than with younger patients. Furthermore, baseline abnormalities such as BBB, pacers, and prior MIs may make the ECG more difficult to interpret.



Samaras, N, Chevalley, T, et al.  “Older patients in the emergency department: a review.”  Ann Emerg Med. 2010;56:261-269.