Kamuran Çelik, Erol Armağan, Erman Uygun, Havva Özge Özkan Yıldız, Sibel Gafuroğulları, Halil Kaya, Funda Yılmaz, Melih Yüksel

Comparison of the etiological causes in patients under and/or over the age of 65 admitted to the emergency department with non-traumatic chest pain

Objectives: One of the most common reasons for admission to the emergency department is chest pain. The clinical presentation of chest pain is quite wide. The study aimed to compare the diagnoses of patients under and/or over the age of 65 admitted to the emergency department with non-traumatic chest pain.Methods: A thousand patients admitted to the emergency department with non-traumatic chest pain between 15.10.2014 and 15.07. 2015 were included in the study. Patients were divided into two groups according to age group as < 65 years old and ≥ 65 years old. Age, gender, the type of admission, comorbidities, accompanying symptoms, diagnosis, outcome and hospitalization were recorded.Results: Five hundred eighteen males and 482 females were included in the study. Eight hundred nineteen patients were between the ages of 18 to 64. The most common accompanying symptom was dyspnea in both age groups. Hypertension was the most common concomitant disease in the 18-64 year age group while coronary artery disease was the most common diseasein the 65 and over age group. Conclusions: Non-cardiac chest pain is more common in the young population admitted to the emergency department while life-threatening chest pain is more common in the population over the age of 65.

PDF

___

1. Brown JB. Chest Pain. In: Marx JA, editor. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia: Saunders; 2014: pp. 214-22.
2. Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand J-P, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007;28:1598-660.
3. Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA 2005;294:2623-9.
4. Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Aldous S, et al. The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol 2013;12:121-6.
5. Ruigomez A, Rodriguez LA, Wallander MA, Johansson S, Jones R. Chest pain in general practice: incidence, comorbidity and mortality. Fam Pract 2006;23:167-74.
6. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125:e2-e220.
7. Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Eng J Med 2000;342:1187-95.
8. Goodacre S, Cross E, Arnold J, Angelini K, Capewell S, Nicholl J. The health care burden of acute chest pain. Heart 2005;91:229-30.
9. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Eng J Med 2000;342:1163-70.
10. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation 2011;123:e18-e209.
11. Coşkun SÖ, Parlak İ, Değerli V, Elçin G, Denizlioğlu B, Yıldırım E, et al. [Evaluating the acute coronary sendrom rates of the patients who apply to emergency service with chest pain]. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi 2015;19:84-94.[Article in Turkish]
12. Madsen TE, Fuller M, Hartsell S, Hamilton D, Bledsoe J. Prospective evaluation of outcomes among geriatric chest pain patients in an ED observation unit. Am J Emerg Med 2016;34:207-11.
13. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163:2345-53.
14. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al.; American College of Cardiology, American Heart Association. Committee on the Management of Patients With Unstable Angina. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002;40:1366-74.
15. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol 2004;44:E1-E211.
16. Orak M, Ustündağ M, Güloğlu C, Ozhasenekler A, Alyan O, Kale E. The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform. Am J Emerg Med 2010;28:891-6.