Frequency of ACS among Patients Presenting with Atypical Presentation in the National Institute of Cardiovascular Diseases Emergency Room
Frequency of ACS among Patients Presenting with Atypical Presentation
DOI:
https://doi.org/10.54393/pjhs.v7i2.3709Keywords:
Acute Coronary Syndrome, Atypical Presentation, Dyspnea, Emergency Department, TroponinAbstract
Acute coronary syndrome (ACS) classically presents with chest pain; however, many patients present atypically, which can delay diagnosis and treatment. Objectives: To determine the frequency of ACS among patients presenting with atypical symptoms to the emergency room of the National Institute of Cardiovascular Diseases (NICVD), Karachi. Methods: This prospective cross-sectional study was conducted in the NICVD emergency room from 28 May to 27 September 2025. Adults aged 18–80 years presenting with atypical symptoms (dyspnea, fatigue, epigastric pain, dizziness, or syncope ± chest pain) were consecutively enrolled (n=165). ACS was defined by ischemic ECG changes and/or elevated troponin I/T and confirmed by a consultant cardiologist. Associations were assessed using Chi-square or Fisher’s exact tests; p<0.05 was considered statistically significant. Results: Mean age was 61.8 ± 12.6 years; 54.5% were male. ACS was diagnosed in 49 patients (29.7%). Dyspnea was the most common symptom (40.0%) and was significantly associated with ACS (51.0% vs 35.3%; p = 0.031). ACS was more frequent in patients aged ≥60 years (36.5% vs 18.9%; p=0.012). Hypertension (p=0.021), diabetes (p=0.038), and obesity (p=0.047) were significantly associated with ACS. Conclusions: Approximately one in three patients presenting atypically in the NICVD emergency room had ACS. Older age, dyspnea, hypertension, diabetes, and obesity were significantly associated with ACS, supporting early ECG and troponin testing in atypical presentations.
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