[Myocardial infarct in the admissions and emergency service: a particular entity or predominant atypia?...].

The diagnosis of myocardial infarction in patients seen in the emergency ward warrants special attention. As demonstrated by Leconte et al. in this issue of La Presse Médicale, only 61% of them have typical chest pain. Nearly 7% have no pain and even 1.1% have no recognizable symptoms of myocardial infarction at all! These authors also observed that the frequency of atypical presentations increases with age. Emergency ward patients with myocardial infarction are indeed a particular population simply due to the mere fact that their symptoms did not lead to pre-hospital care by a mobile emergency unit. Considering the flow of patients in the emergency ward (myocardial infarction accounts for only 0.4% of diagnoses) and the percentage of patients in cardiac intensive care units referred from the emergency ward (23% in our unit) it is clear that special attention should be given to entertaining the diagnosis of myocardial infarction more widely in the emergency ward, particularly in older patients.