Peer Reviewed
GP emergency management

Is this a case of acute coronary syndrome?

Gordian Fulde, Farzad Jazayeri
Abstract
An 82-year-old man presents to his GP with tiredness and decreasing exercise tolerance. What are the differential diagnoses and how do you investigate this patient?
Key Points
  • Ischaemic heart disease presents atypically in elderly patients and can easily be missed. In the acute setting, the diagnosis could solely rely on testing of cardiac biomarkers.
  • Lifestyle modification to reduce cardiovascular disease is of great importance in all age groups but especially so in elderly populations because the risk of complications of any invasive treatment is much higher in elderly patients than in younger patients.
  • There are many different modalities for screening for ischaemic heart disease. Each test is associated with pros and cons, which need to be considered for each individual patient.
  • Atypical onset of a respiratory condition could be a warning symptom of cardiac ischaemia.

    Picture credit: © Istockphoto/Willowpix. Models used for illustrative purposes only.

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