This is EMKases, EM Quick Hits podcast.

Quick. Let's get on with it.

EM cases is part of Shremie, the Schwartz-Riseman Emergency Medicine Institute.

That's the nonprofit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for general information and educational purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physician. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their individual capacity, not on behalf of the Institute nor Medicine Cases.

First up, we've got the first of a brand new quick hit series on geriatric emergencies with Dr. Christina Shenvi, Associate Professor of Emergency Medicine at Chapel Hill at North Carolina,

where she's the director of the Office of Academic Excellence and President of the Association for Professional

Women in Medical Sciences. She did a fellowship in geriatric EM and she's got a fantastic podcast

dedicated to geriatric emergency medicine since 2015 called Gemcast, GEMC, check it out wherever you get

your podcast.

She's going to talk to us about how not to miss ACS and older patients.

When we think about older patients with ACS, the difficulty in diagnosing comes from the fact that they often present with what I'll put in scare quotes here as atypical symptoms.

Now, let's think a little bit about where this idea of typical and atypical comes from.

We refer to typical ACS symptoms as that crushing substernal chest pain radiating to the shoulder with diaphoresis and shortness of breath. And then when a patient comes in, feeling more

fatigued, feeling weak and dizzy, or just feeling more short of breath going up the stairs,

we call that atypical. However, that comes more from our definitions and assumptions

than it does from how patients actually present. So why do patients who are older break these,

quote unquote, rules? Well, it has to do with how they were defined. And in fact, you can look back to the 1700s,

where, quote, typical ischemic symptoms were described. And they were described as a painful

sensation in the breast accompanied by a strangling sensation, anxiety, and occasional radiation

to the left arm, often worse with exertion

and relieved by rest. But guess what? Those typical symptoms were not described in populations

who were elderly and often not described in women. And through the years, elderly patients have often been excluded from trials,

...