When dyspnea replaces chest pain: Age-dependent symptom profiles in ACS and non-ACS patients undergoing coronary angiography
When evaluating an elderly patient with suspected cardiac ischemia, do not dismiss dyspnea as merely non-cardiac; it should prompt a full workup for ACS. Remember that the typical chest pain presentation is less reliable in advanced age. Always maintain a high index of suspicion for underlying coronary pathology even when the primary complaint is shortness of breath.
This article highlights an important, age-related shift in the typical presentation of suspected coronary disease. The key finding is that as patients get older, their symptoms are increasingly characterized by dyspnea rather than isolated chest pain, and this pattern holds true whether or not they ultimately have Acute Coronary Syndrome (ACS). This suggests that relying solely on classic anginal chest pain history in our elderly population may lead to underdiagnosis. Therefore, the authors strongly recommend treating dyspnea as a high-risk symptom requiring thorough evaluation for ACS and other significant cardiovascular issues in older patients.