Atypical Chest Pain in the Elderly: Prevalence, Possible Mechanisms and Prognosis

Acute chest pain is one of the most common causes of emergency department (ED) visits. In the United States, more than 5 million people attend the ED with chest pain each year, and more than 3 million of these patients are hospitalized because of this condition at a cost of more than 6 billion dollars1–3. Early recognition of clinically life-threatening conditions, such as pulmonary embolism, aortic dissection and pneumothorax, are crucial. Furthermore, early diagnosis and accurate diagnostic tools with subsequent appropriate treatment strategies are important and can save lives, since failure to recognize such diseases at an early stage may lead to a delay in treatment. Of all patients who present at the ED with acute chest pain, less than 25% have acute coronary syndrome (ACS)4. A recent study revealed that ACS actually comprised one-third of myocardial infarction (MI) and two-thirds of unstable angina or non-ST-segment elevation MI patients. It has been previously mentioned that approximately 4% of patients with MI were inappropriately discharged from the ED in a prospective multicenter trial involving 3,077 patients5. Christenson et al.6 reported that up to 4.6% of patients with acute MI and 6.4% of patients with unstable angina were misdiagnosed in the ED in Canada in 2004, while a lower rate was reported in the USA by Pope et al.7 In a prospective observational study with a focus on the prevalence, clinical characteristics and outcomes of ATYPICAL CHEST PAIN IN THE ELDERLY: PREVALENCE, POSSIBLE MECHANISMS AND PROGNOSIS