BMJ 1994;308:1159 (30 April)

Letters

Presentation is often pain free in elderly patients

EDITOR,--Regrettably, guidelines for timely administration of thrombolytic agents in suspected myocardial infarction1 fail to take cognisance of the fact that about a third of elderly patients with this diagnosis have a pain free presentation, characterised by sudden onset breathlessness, mental confusion, or collapse.2 The time of onset of these symptoms, accurately identified, is equivalent to time of onset of chest pain for the purposes of thrombolytic treatment if the diagnosis is subsequently confirmed by electrocardiography. The indications for treatment would be similar to those already in use for patients presenting with chest pain.1

O M P Jolobe 

Consultant geriatrician, Department of Medicine for the Elderly, Tameside General Hospital, Ashton under Lyne OL6 9RW.

  1. Weston CFM, Penny WJ, Julian DG. Guidelines for the early management of patients with myocardial infarction. BMJ 1994;308:767-71. (19 March.) [Free Full Text]
  2. Bayer AG, Chandra JS, Farag RR, Pathy MSJ. Changing presentation of myocardial infarction with increasing age. J Am Geriatr Soc 1986;34:263-6. [Medline]

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Relevant Article

Guidelines for the early management of patients with myocardial infarction
C F M Weston, W J Penny, and D G Julian
BMJ 1994 308: 767-771. [Extract] [Full Text]

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