[Diagnostic difficulties of myocardial infarct in an admissions and emergency service: influence of age].
OBJECTIVE
To analyze the clinical signs and electrocardiographic and enzyme data in patients admitted to an emergency ward for myocardial infarction in order to highlight diagnostic pitfalls.


METHODS
All 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. Patient files were randomly selected (n = 257 files) for review by an emergency ward specialist and a cardiologist to identify cases of myocardial infarction (n = 88 patients, mean age 73.4 +/- 15.2 years). Clinical, electrical and enzyme data (including CPK-MB) were analyzed.


RESULTS
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. The admission electrocardiogram showed complete criteria for myocardial infarction in 43% of the cases, incomplete criteria in 21% and was non-contributive in 36%. Enzyme results were elevated in 78% of the cases at the first assay and in 98.2% at the second assay. Both typical chest pain and ECG were observed in only 30% of the cases. Chest pain was present in 55% of the patients over 75 years of age and in 81% of those under 75 years (p = 0.007).


CONCLUSIONS
A typical syndrome is observed in less than one-third of all patients with myocardial infarction admitted to emergency wards. The frequency of atypical presentations increases with age.
Le Conte
P
P
Service d'Accueil et d'Urgence, Centre Hospitalier Universitaire, Nantes. pleconte@sante.univ-nantes.fr
Hulot de Collart
G
G
Chevalier
J C
JC
Yatim
D
D
Touzé
M D
MD
Garrec
F
F
Baron
D
D
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004796:Clinical Enzyme Tests; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase
Difficultés diagnostiques de l'infarctus du myocarde dans un service d'accueil et d'urgence: influence de l'âge.