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Introduction
Age-associated changes in older adult patients often cause atypical presentations, which complicates the assessment and treatment of their health problems. Various pathologies and impaired homeostasis are the two main issues that are regarded as the premises of atypical symptoms in this population. This paper aims to examine a case of a patient who had vomiting as the only sign of myocardial infarction, which was identified in the course of the health evaluation process.
Vomiting and Myocardial Infarction in a Patient
One of the key symptoms of myocardial infarction is chest pain with moderate or severe intensity, of compressive or burning fashion. There may be associated symptoms such as severe weakness, cold, sweat, tremors, dyspnea, coughing, dizziness, et cetera (Jung et al., 2017). A person may experience emotional increase, and behavioral disorders may be observed, including the development of psychosis. Also, a heart attack or a pre-drug state may be accompanied by nausea, vomiting, and abdominal distension.
An 86-year-old man was hospitalized with vomiting that was present 2-3 times daily within the last three days. In the given patient, none of the mentioned symptoms except for vomiting were present. Betancourt, Hames, and Rivas (2015) state that many older adult patients develop atypical symptoms that can be divided into three categories, including vague, altered/unexpected, and asymptomatic. At the same time, it should be emphasized that geriatric patients are less likely to experience and complain of chest pain in the pre-myocardial infarction phase, “ranging from 4.7% to 33% with poorer clinical outcomes” (Jung et al., 2017). In the emergency, it is especially important to recognize atypical symptoms and understand them properly (Hofman, van den Hanenberg, Sierevelt, & Tulner, 2017). Based on the mentioned considerations, the geriatric care doctor who evaluated this patient assumed cardiac problems and referred him to further diagnostics.
To ensure proper patient evaluation, three diagnostic measures were applied, such as the electrocardiogram (ECG), the blood test, and physical assessment. As the recording of the electrical activity of the heart, ECG allowed determining that vomiting is related to heart problems as well as their severity. The visual diagnosis methods, including echocardiography and perfusion scintigraphy, helped to confirm that the patient had a heart attack within the last day. In addition, blood tests revealed an increase in the levels of troponins and CK-MB, which indicate heart damage.
Among the strategies that were implemented to compensate for heart failure of the given patient, there was the implementation of a statin regimen, and appropriate rest. To eliminate vomiting, Pedialyte was assigned for rehydration purposes (Engberding & Wenger, 2017). More to the point, liquid drinking and dieting were regulated accordingly: 3/5 was composed of complex carbohydrates and proteins, and salt intake was eliminated. The daily amount of food was divided into 4-5 small portions, and the gap between meals in 2-3 hours was maintained.
Conclusion
To conclude, the atypical presentations are common in older adult patients since they have affected homeostasis and multiple chronic diseases. The evidence shows that vomiting can be the only symptom of cardiac issues, which points to the need to pay attention to this concern of the given population. The case of the patient that was considered in this paper clarifies that evaluation and treatment of geriatric patients with atypical symptoms should involve a range of tools and tests to ensure that their conditions were understood correctly, and the most relevant treatment option was selected.
References
Betancourt, G., Hames, E., & Rivas, K. (2015). Atypical presentations of common conditions in geriatric patients. Journal of the American Medical Directors Association, 16(3), B5.
Engberding, N., & Wenger, N. K. (2017). Acute coronary syndromes in the elderly. F1000Research, 6, 1791-1798.
Hofman, M. R., van den Hanenberg, F., Sierevelt, I. N., & Tulner, C. R. (2017). Elderly patients with an atypical presentation of illness in the emergency. Netherlands Journal of Medicine, 75(6), 241-246.
Jung, Y. J., Yoon, J. L., Kim, H. S., Lee, A. Y., Kim, M. Y., & Cho, J. J. (2017). Atypical clinical presentation of geriatric syndrome in elderly patients with pneumonia or coronary artery disease. Annals of Geriatric Medicine and Research, 21(4), 158-163.
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