UMEM Educational Pearls

Category: Geriatrics

Title: ACS in Elderly Patients (Submitted by Dr Katherine Grundmann)

Keywords: Geriatric, cardiology, symptoms, atypical, angina (PubMed Search)

Posted: 6/4/2017 by Danya Khoujah, MBBS
Click here to contact Danya Khoujah, MBBS

Older patients with acute coronoary syndrome (ACS) are less likely to present with typical ischemic chest pain (pressure-like quality, substernal location, radiating to jaw, neck, left arm/shoulder and exertional component) compared with younger counterparts.

Typical angina symptoms predictive of acute myocardial infarction (AMI) in younger patients were less helpful in predicting AMI in the elderly population.

Autonomic symptoms such as dyspnea, diaphoresis, nausea and vomiting, pre-syncope or syncope are more common accompaniments to chest discomfort in elderly ACS patients.

Symptoms may also be less likely to be induced by physical exertion; instead, they are often precipitated by hemodynamic stressors such as infection or dehydration

Bottom Line: Keep a high index of suspicion for ACS in older patients as they present atypically.


Dai X, Busby-Whitehead J, Alexander KP. Acute Coronary Syndrome in the older adults. J Geriatr Cardiol. 2016 Feb;13 (2): 101-108