Atypical chest pain in the elderly: prevalence, possible mechanisms and prognosis.

SUMMARY Acute chest pain is a major complaint quite commonly presented at emergency departments. A differential diagnosis of acute chest pain includes various disease entities, including some life-threatening disorders. Of these, acute coronary syndrome garners much clinical attention and forms a specific disease that includes a critical ST-segment elevation myocardial infarction and a less severe form of non-ST-segment elevation myocardial infarction and unstable angina. As an urgent and life-threatening disease leading to a high morbidity and mortality, accurate diagnosis of acute coronary syndrome remains a clinical challenge. Efficient management of this syndrome may rely on a quick yet accurate diagnosis. A high misdiagnosis rate and inappropriate discharge rate for acute coronary syndrome are still observed, especially in the elderly population, owing to a higher prevalence of atypical symptoms presented in this group. Moreover, the existence of high comorbidities in the elderly population makes effective clinical approach complicated. A delay in the identification and treatment may lead to worse outcomes in this patient population. The underlying pathophysiology and exact mechanisms are various. Patient evaluation strategies are currently being developed, as are new diagnostic facilities aimed at preparing physicians for urgent intervention in a more cost-effective