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Older patients, and particularly older women, often present with non-chest pain ischemic symptoms, and, as was the example in the associated Patient Case Quizthe "GI symptoms" represent myocardial ischemia. Other common presentations are severe dyspnea, fatigue, dizziness, or syncope and not uncommon are confusion Older adults symptoms of myocardial infarction altered cognition.

The electrocardiographic diagnosis of STEMI is frequently complicated by an abnormal baseline electrocardiogram, often reflecting left ventricular hypertrophy, prior MI, conduction system disease, and at times the presence of atrial fibrillation.

STEMI presenting as new left bundle branch block is far more common at advanced age. There is an increased risk of cardiogenic shock with acute STEMI in those older than 70 years of age, with a systolic BP below mm Hg, sinus tachycardia in excess of beats per minute bpm or a heart rate less Older adults symptoms of myocardial infarction 60 Older adults symptoms of myocardial infarction, and a longer time since symptom onset.

Because of this increased risk of cardiogenic shock, intravenous beta blocker therapy is characteristically deferred. However, the standard STEMI therapy of aspirin, clopidogrel, and unfractionated heparin is appropriate, with particular attention to weight-based dosing for the unfractionated heparin.

Angiotensin-converting-enzyme ACE inhibition and high intensity statin is appropriate. PCI is favored over thrombolytic therapy with data available at least to age 80with documentation of decreased day mortality. There is particular benefit in the aged patient with anterior MI presenting more than 6 hours after symptom onset or with cardiogenic shock. The major benefit of primary PCI is a decrease in risk of ischemic events, and a decreased need for subsequent target vessel revascularization.

Nonetheless, the increased bleeding propensity must be appreciated in older adults. It is uncertain whether this is an age-related vasculopathy involving small hemostasis-maintaining vessels causing impaired vascular healing, loss of anatomic vaso-reactivity, or immune incompetence.

The patient factors contributing to bleeding risk include anemia, renal dysfunction, heart failure, and diabetes Older adults symptoms of myocardial infarction well as female gender, low body weight, a prior history of bleeding, and peripheral vascular disease.

Prominent for bleeding risk are catheter based interventions and inappropriate dosing of anticoagulants weight, renal function based. The post-procedure recommendations are early ambulation and deep vein thrombosis prophylaxis with compression apparatus.

Secondary prevention medications are comparable as for younger patients, with high-intensity statin showing greater benefit at age greater than 65 years than at younger age. Primary angioplasty vs. Eur Heart J ; J Am Coll Indian girls naked pics ;61; Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: In collaboration with the Society of Geriatric Cardiology.

Circulation ; Acute coronary syndrome management in older adults: guidelines, temporal changes and challenges. Age Ageing ; Acute coronary syndrome Older adults symptoms of myocardial infarction older patients: a review. Cardiol Rev ; Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments. Arch Cardiovasc Dis ; Impact of age on treatment and outcomes in ST-elevation myocardial infarction.

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