Thompson L, Wood C, Wallhagen M
Crit Care Nurs Clin North Am. 1992 Jun;4(2):291-9.
The presentation of an AMI in the older person is often atypical, with a lower incidence of classic chest discomfort but increasing incidence of dyspnea, syncope, stroke, and acute confusion. Atypical presentation is especially common in those 85 years and older. The altered pattern of symptoms predisposes the elderly to a delayed or missed diagnosis. Delay in diagnosis may also occur when the ECG is nondiagnostic. In addition, enzyme elevations may be lower and fail to reflect the extent of myocardial damage. Thus, among the greatest challenges confronting critical care nurses is that of caring for elderly patients presenting with atypical AMI and concomitant polypathology. Nurses who are well informed about the normal age-related changes in the cardiovascular system contribute to more accurate and timely diagnosis and treatment of AMI in the elderly.
老年人急性心肌梗死（AMI）的表现往往不典型，典型胸痛的发生率较低，但呼吸困难、晕厥、中风和急性意识模糊的发生率不断增加。非典型表现在85岁及以上的人群中尤为常见。症状模式的改变使老年人更容易出现诊断延迟或漏诊。当心电图无法确诊时，也可能发生诊断延迟。此外，酶升高可能较低，无法反映心肌损伤的程度。因此，重症护理护士面临的最大挑战之一是护理患有非典型AMI和合并多种病理情况的老年患者。熟悉心血管系统正常年龄相关变化的护士有助于更准确、及时地诊断和治疗老年人的AMI。
