Which symptom is most common in MI among elderly patients?

• A. Chest pain
• B. Shortness of breath
• C. Syncope
• D. Nausea

Answer: (B)

In elderly patients, myocardial infarction often presents with shortness of breath rather than classic chest pain. Aging and common comorbidities like COPD and diabetes can blunt or mask chest pain, so ischemia may manifest primarily as dyspnea. Additionally, reduced myocardial function from infarction increases left-sided pressures and can cause pulmonary edema, which drives the feeling of breathlessness. While chest pain can occur, it’s less reliably present in older adults, and other atypical signs such as fatigue, confusion, syncope, or nausea may accompany, with dyspnea remaining the most frequent single symptom. Clinically, this means that any older patient with new or worsening shortness of breath should raise suspicion for a myocardial infarction, prompting urgent ACS evaluation with ECG and troponin, along with appropriate management. Recognizing this pattern helps prevent delays in treatment and improves outcomes in the elderly.