Acute Coronary Syndrome in Octogenarians: Expect the Unexpected

BACKGROUND

Ischemic heart disease is the leading cause of death in the United States and the world. Advanced age is the strongest risk factor for ischemic heart disease and the best independent predictor for poor outcomes after acute coronary syndrome (ACS). Elderly patients are at high risk for ACS, and numerous studies have shown that octogenarians in particular experience increased morbidity and mortality compared to younger patients.

CASE REPORT

We describe a case of an 83-year-old woman who presented to the emergency department with a chief complaint of sore throat and was found to have a non-ST elevation myocardial infarction (NSTEMI) and was treated successfully with primary coronary intervention (PCI). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Chest pain is a common presenting symptom for ACS, but elderly patients with MI are more likely to present with other chief complaints. Only 40% of patients in the National Registry of Myocardial Infarction database ≥ 85 years of age had chest pain on initial presentation. Recent studies comparing invasive therapy (PCI or coronary artery bypass graft) with optimal medical therapy for patients > 75 years of age diagnosed with NSTEMI have reported a reduced risk of death and major cardiac events with invasive therapy. Emergency physicians should have a high level of suspicion for ACS in octogenarians, even in those presenting without chest pain. Timely diagnosis and management can improve morbidity and mortality in these patients.

Unusual Pharyngeal Pain Caused by Acute Coronary Syndrome: A Report of Three Cases

Most patients complaining of pharyngeal pain have an upper respiratory tract infection or other local explanation for their pain. Here we show 3 rare cases of patients visiting our Otorhinolaryngology Department who had an initial symptom of pharyngeal pain caused by acute coronary syndrome (ACS). An electrocardiogram and a cardiac biomarker test are recommended to exclude ACS with atypical presentation in cases without pharyngolaryngeal findings comparable to pharyngeal pain.

Acute coronary syndrome presenting with earache and sore throat

Chest pain and discomfort are regarded as the hallmark symptoms of acute coronary syndrome, and the absence of these symptoms are described as “atypical” presentation. In this case, we aimed to report an acute coronary syndrome–diagnosed patient who was admitted to our emergency service with unilateral earache.

Acute myocardial infarction presenting with pharyngeal pain alone

BACKGROUND

Pharyngeal pain alone due to acute myocardial infarction is rare.

CASE REPORT

A 37-year-old man felt sudden pharyngeal pain. He was transferred to a medical facility under a misdiagnosis of pharyngitis. However, he was thereafter found to have acute myocardial infarction and thus was transferred to another hospital. An emergency coronary angiogram revealed complete occlusion of the right coronary artery and he underwent coronary angioplasty. The patient was later discharged ambulatory.

CONCLUSION

A misdiagnosis of acute myocardial infarction can lead to unfavorable outcomes; therefore, physicians or emergency medical technicians should be aware of this disease even when a patient complains of sudden pharyngeal pain alone.