Sinais e sintomas de síndrome coronariana aguda em idosos: uma revisão sistemática

Abstract

Introduction: Acute coronary syndrome (ACS) represents a condition consistent in acute myocardial ischemia or infarction, caused by an abrupt reduction in coronary blood flow. This diagnose is done based on the symptoms, through changes in the electrocardiogram and also in the biomarkers of myocardial necrosis. In the elderly people, the signs and symptoms observed may be atypical. Since there is no consensus about what the atypical symptoms for the elderly are and how atypical it could be, it"s such a relevant concern to identify its presentation to guide a final diagnosis quickly by the health care staff. Objective: To identify the signs and symptoms of acute coronary syndrome in the elderly. Methods: It was a systematic literature review, which had the guiding question: "What are the signs and symptoms presented by the elderly with ACS". The researches were done on the following portals or databases: BVS, Pubmed, Web of Science Core Collection, CINAHL, Scopus, EMBASE, Proquest and Banco de teses Capes. All the studies found were initially screened by reading the titles and abstracts to identify if they met the eligibility criteria. The studies were independently analyzed by three different reviewers. The analysis of methodological quality was performed to verify the risk of methodological bias. Data analysis occurred in a descriptive way and the findings that answered the research question were analyzed qualitatively. Results: From the 280 papers found, only 18 were included on this review. Almost all studies reported the occurrence of angina pain, that may be typical or atypical. The pain could be associated or not with some other equivalent factor of ischemia, such as dyspnea, sweating, nausea and emesis. Other shown symptoms were dizziness, mental confusion, headache, indigestion, diaphoresis, palpitation, fatigue, anxiety, fear and discommodity. Regarding to the signs, two studies indicated the presence of tachycardia and elevation of the arterial pressure. Atypical symptomatology varied between studies from 4.8 to 63.7%. Conclusion: the symptomatology of ACS is commonly atypical in the elderly and there may be absence of symptoms. However, elderly usually have atypical pain, as well as shortness of breath, dizziness, palpitations, fatigue, mental confusion, besides headache, indigestion and diaphoresis. When it comes to signs of ACS in elderly, stands out the elevation of the arterial blood pressure and tachycardia. PROSPERO registration: CRD42020214432.