Characteristics and outcome of chest pain in young adults

OBJECTIVE: To estimate the frequency of acute coronary syndrome (ACS) at 30 days in patients less than 40 years of age reporting with acute chest pain in Emergency Department (ED). DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Emergency Department (ED) of Aga Khan University Hospital, Karachi between July to December 2002. PATIENTS AND METHODS: One hundred young patients with chest pain in whom an electrocardiogram (ECG) was performed. A standardized data collection form was completed. Physical examination included initial vital signs and presence or absence of jugular venous pressure (JVP), rales, or fourth heart sound. Outcome variables were seen in the patients admitted or discharged within 30 days of reporting to the ED. RESULTS: Out of one hundred young patients in the study, 24 had an ACS. Of those, 22 (91.66%) were males and their mean age was 35 years. Most of these patients had cardiac risk factors on physical findings. The final diagnosis of patients consisted of 47 patients with atypical chest pain, 20 with acute myocardial infarction (AMI), 16 with musculoskeletal chest pain, 7 with psychogenic chest pain, 4 with angina, 4 with others and 2 with gastritis. CONCLUSION: Young patients, presenting to ED with chest pain, had a greater likelihood of suffering from ACS if they were male and between 30 to 40 years of age. People of any age group, presenting to ED with chest pain should not be disregarded in the presence of cardiac risk factors and positive physical findings