Delayed recognition of myocardial infarction (MI) in the emergency department is common when patients present without chest pain. This retrospective chart review examined atypical MI presentations among 316 patients seen at two emergency departments from April 2004 to August 2006. Of patients diagnosed with MI, 38.6% presented with unrecognized, atypical symptoms. Pain in non‑chest areas was the strongest predictor of atypical MI and was associated with diagnostic and treatment delays. Additional predictors included dizziness, prior stroke, age over 65 years, and white race. Findings support development of emergency department guidelines to improve early identification and timely treatment of atypical MI.
