Influence of age on pain perception in acute myocardial ischemia: A possible cause for delayed treatment in elderly patients

• Published in: International journal of cardiology 2011-05, Vol.149 (1), p.63-67
• Main Authors: Rittger, H, Rieber, J, Breithardt, O.A, Dücker, M, Schmidt, M, Abbara, S, Sinha, A.M, Jakob, A, Nölker, G, Brachmann, J
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Age Factors; Aged; Aging - physiology; Aging - psychology; Angioplasty, Balloon, Coronary - psychology; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Clinical symptoms; Coronary heart disease; Elderly patients; Electrocardiography; Heart; Humans; Ischemic Preconditioning - methods; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocardial Infarction - psychology; Myocardial Ischemia - diagnosis; Myocardial Ischemia - physiopathology; Myocardial Ischemia - psychology; Myocarditis. Cardiomyopathies; Pain Measurement; Pain Threshold - physiology; Pain Threshold - psychology; Prospective Studies; Reaction Time - physiology; Reduced pain perception; Somatosensory Disorders - physiopathology; Somatosensory Disorders - psychology; Time delay; Time Factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2009.11.046

Abstract Background Elderly patients tend to seek later for medical help during myocardial infarction. This may be caused by impaired pain perception with ageing. The aim of our study was to prospectively evaluate age-dependent differences in pain perception during temporary induced coronary ischemia. Methods In 102 patients (68 male, age 68 ± 11 years) undergoing percutaneous coronary intervention, ischemia was induced by balloon inflation for up to 120 s. Time to onset of perceived pain, pain characteristics and pain severity (0 = no pain, 100 = worst pain possible) was registered. This was repeated twice to evaluate ischemic preconditioning. A 12 lead ECG-tracing was simultaneously recorded. Patients were divided by their median age into 2 groups with comparable demographics: ≤ 69 years (group 1) and > 69 years (group 2). Results Group 1 patients demonstrated earlier onset of pain (most apparent during the second inflation: 31 ± 15 s vs. 46 ± 26 s; p < 0.001), and greater pain severity (inflation #1: 64 ± 21 vs. 51 ± 25 [ p = 0.017]; #2: 66 ± 23 vs.52 ± 27 [ p = 0.008]; #3: 63 ± 23 vs. 54 ± 24 [ p = 0.085]). ST-changes did not differ (0.24 ± 0.10 vs. 0.20 ± 0.14, [ p = 0.18]; 0.27 ± 0.17 vs. 0.20 ± 0.14, [ p = 0.11]; 0.19 ± 0.13 vs. 0.16 ± 0.09; [ p = 0.32]). Time from occlusion to onset of ECG changes did not differ between the groups, but increased with repetitive inflations (inflation #1: 29 ± 11 s vs. 29 ± 11 s; #2: 31 ± 14 vs. 33 ± 11; #3: 39 ± 21 vs. 40 ± 15 s [increase p = 0.017; p < 0.001]). Conclusion These data suggest that the perception of pain from myocardial ischemia in the elderly is significantly less severe and delayed compared to younger patients.