Research ArticleResearch

Nearly 1 in 5 confirmed heart attacks arrived without chest symptoms, more often in patients with impaired function or consciousness

Journal of Emergency Nursing (PubMed)Jun 30, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a retrospective cohort of 1076 adults aged 40 or older with acute myocardial infarction at a Taiwan teaching hospital, 19% presented without chest-related symptoms, and reduced level of consciousness and greater functional dependence were each independently linked to these atypical presentations.

What NurseJet pulled from the source

This retrospective cohort study used electronic health record data from a regional teaching hospital in Taiwan, including 1076 adults aged 40 years or older diagnosed with acute myocardial infarction between 2016 and 2023. Presentations were classified as typical (chest pain or chest tightness) or atypical (absence of chest-related symptoms). Among the 1076 patients, 19.0% presented without any chest-related symptoms. Patients with atypical presentations were older, had lower body mass index, greater dependence in activities of daily living, and lower Glasgow Coma Scale scores. In multivariable logistic regression, reduced level of consciousness (odds ratio 4.93; 95% CI 2.41 to 10.05; P < .001) and greater functional dependence (odds ratio 1.10; 95% CI 1.06 to 1.15; P < .001) were each independently associated with atypical presentation.

Why this matters for nurses

Emergency nurses are often the first to size up a patient at triage, and chest pain is widely treated as the signature of a heart attack. This study may matter for nurses because nearly one in five confirmed myocardial infarctions arrived without chest symptoms, and the patients most likely to present atypically were those with cognitive or functional impairment who can least advocate for themselves.

Bedside takeaway

Be aware that in this cohort about 1 in 5 confirmed heart attacks came without chest symptoms, and atypical presentation was more likely in patients with reduced consciousness or greater functional dependence.

Key takeaways

Among 1076 adults aged 40 or older with acute myocardial infarction, 19.0% presented without any chest-related symptoms.
Reduced level of consciousness was independently associated with atypical presentation (odds ratio 4.93; 95% CI 2.41 to 10.05; P < .001).
Greater functional dependence in activities of daily living was also independently associated (odds ratio 1.10; 95% CI 1.06 to 1.15; P < .001).
Patients with atypical presentations tended to be older with lower body mass index and lower Glasgow Coma Scale scores.

Practice implications

For emergency nurses, the findings suggest a heart attack cannot be ruled out on the absence of chest pain alone, especially in older adults or those with reduced consciousness or high dependence in activities of daily living. Folding functional status and Glasgow Coma Scale into the triage picture, and keeping a lower threshold for cardiac workup in impaired patients, may help catch atypical presentations earlier.

Limitations & cautions

This was a single-center retrospective cohort at one regional teaching hospital in Taiwan, drawing on electronic health record data from 2016 to 2023, so practice and documentation patterns may not generalize elsewhere. The observational design shows association, not causation, and only patients already diagnosed with acute myocardial infarction were included, so the study cannot speak to how often atypical presentations are missed entirely.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Journal of Emergency Nursing (PubMed)

Journal of Emergency Nursing (PubMed). Emergency Nursing Recognition of Atypical Acute Myocardial Infarction: Associations With Functional Status and Level of Consciousness-A Retrospective Cohort Study.

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https://pubmed.ncbi.nlm.nih.gov/42377288/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

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Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

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European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

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At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

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European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

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Intraoperative rescue fentanyl use did not differ significantly between groups.
Hypotension was more common with dexmedetomidine, while postoperative shivering was less common.
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Why this matters on shift

An opioid-sparing label did not translate into better early pain control in this trial, and the differing hypotension and shivering profiles remain relevant during perioperative handoff and recovery monitoring.

Bedside takeaway

Monitor pain, hemodynamics, sedation, and shivering in relation to the analgesic regimen and local protocol.

Nursing implications

During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
AI-summarized from the linked source. Review the original article before applying to practice.

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Key takeaways

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More updates for this clinical area

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