SESSION TITLE: CAD/Coronary Syndromes Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: The anterior chest pain is one of the most frequent symptoms in the elderly, because of the multiple and various diseases at this age. We aimed to describe the experience of a Geriatrics-Gerontology Clinic regarding the characteristics and special features of chest pain in the elderly.
METHODS: We performed a retrospective study on 230 patients with anterior chest pain, admitted in the Vth Internal Medicine and Geriatrics-Gerontology Clinic Iasy between June 2011 and June 2013. We carefully appealed to history taking and clinical diagnosis in order to avoid excessive and unnecessary investigations.
RESULTS: The mean age of the studied patients was 70.5. The most frequent pathology involved was the ischemic heart disease (73.4%). In 9 cases (3.8%), a thoroughly differential diagnostic was needed, because of the important associated diseases. There were differentiated acute coronary syndromes (ACS) with repetitive chest pain, localized predominantly parasternal and irradiated paravertebral and subacromial in patients with age > 60.5 years, hypertensives (3), type 2 diabetes (3), obesity class II - III (2) or patients with a history of chronic lung and abuse of sympathomimetic (1). In these cases, we specified the comorbidities that have underlined the diagnosis of thoracic anterior pain: ·constrictive pericarditis, a patient with corticosteroid dependent asthma; ·fixed hiatal hernia, a patient with ischemic chronic pain; ·a big esophageal diverticulum, a patient with obesity and essential hypertension; ·herpes zoster on the left hemithorax, which appeared after 7 days of hospitalization, a patient with arrhythmia and electrocardiographic ischemia; ·secluded pleurisy, a patient with chronic ischemic heart diseases and chronic heart failure class III - IV NYHA; ·an old diaphragmatic rupture, with rise of the left diaphragm, a patient with chronic ischemic heart disease and chronic heart failure class II-III NYHA.
CONCLUSIONS: Anterior chest pain is a common symptom in medical practice in people older than 65, because of the multitude of conditions that can produce it. The most frequent cause is ischemic heart diseases (60.8% cases), the ECG and/ or echocardiography being needed for routine. The existence of associated pathology requires further detailed investigations (imaging and interventional radiology), especially in people older than 65 and the use of complex and specific treatment.
CLINICAL IMPLICATIONS: Detecting the causes of chest pain in elderly with different comorbidities, other than cardiac pathologies.
DISCLOSURE: The following authors have nothing to disclose: Dragos Munteanu, Rodica Ghiuru, Paloma Manea, Cringuta Paraschiv, Paraschiva Postolache, Cristina Maria Gavrilescu
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