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The “typical” heart attack patient presents with midline chest pain, sweating, and nausea. Certainly, this was not the case with a young man whose only complaint to ED providers was some dizziness.
“Fortunately, based on our triage system, every dizzy patient gets an ECG. The patient’s STEMI was recognized very rapidly,” says Andrew P. Pirotte, MD, an EP at University of Kansas Hospital and a clinical assistant professor at University of Kansas in Lawrence.
The patient experienced a good outcome. “But the dissimilarity between his complaint and his pathology was striking,” Pirotte notes. Other recent STEMI patients exhibited similarly atypical symptoms. “Many geriatric patients have presented with fatigue and weakness and were diagnosed with STEMI,” Pirotte adds.
The number of STEMI presentations at U.S. EDs declined approximately 30% between 2006 and 2011, according to the authors of a 2015 study.1 “Timely diagnosis of STEMI in the ED may be more challenging as a result of these changing demographics,” says lead author Michael Ward, MD, PhD, MBA, assistant professor in the department of emergency medicine at Vanderbilt University Medical Center. STEMI cases decreased from 300,466 in 2006 to 227,343 in 2011. The researchers suggested this could be because some STEMI patients bypass the ED and go directly to cardiac catheterization. Also, the decline could be attributed to the fact that medical management is reducing the number of STEMI cases seen in EDs.
Notably, the decrease was most pronounced in patients age 65 years and older. This suggests that younger patients, who tend to present with symptoms other than chest...