EF
Liu
ffi
Shan
CORONARIES
IN THE
ELDERLY:
FACTORS
OF
MISDIAGNOSIS
Coronaries are
a
common disease
in
the elderly. ln China, the incidence
rate
is
0.7
-
22o/o.
For males, the peak
age group
is
50-59 and
for
females, 60-
69.
Unfortunately, diagnosis
is
more
often missed
in
the elderly.
Many eld-
erly
people never have routine checks
when
they
have no symptoms
but,
when symptoms
do
appear,
it
may
be
too
late
already.
Beware of all
the
risk
factors: hypertension, diabetes, obesity,
high cholesterol, smoking and drinking.
Angina
in
the elderly
is
often
atypical:
tightness
in
the chest
is
precipitated by
tiredness, heavy
meal,
emotional stress
and cold weather. lschaemic heart dis-
ease
is
due to hardening
of
the coro-
naries
so
that heart muscles have
in-
sufficient blood supply;
a
much
more
serious type may cause instantaneous
death, even without
any
warning.
ln
the
elderly,
even
the
electro-cardiogram
(ECG) may not be typical in 10-15%
of
such patients. ln case of doubt,
the
ECG may have
to
be repeated up to 3
times
in 24 hours before the diagnosis
could
be made.
A
series of blood tests
may
also
be done
for
diagnosis
of
coronaries: CPK,
LDH and AST but
their
useful window is narrow and may lead
to
misdiagnoses 3-4 days after
the
attack.
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