During one match, he suffered a brief syncopal episode on the court. He was emergently transported to the nearest acute care center. The patient recovered completely with intravenous hydration, and he was discharged with the presumptive diagnosis of dehydration. That evening he was found dead at home. The autopsy revealed a massive myocardial infarction with extensive coronary artery disease as the cause of death.
Atypical presentations become more common with age because of diminished adrenergic responsiveness.
Older patients, including active seniors, are more likely to present with dyspnea, syncope, delirium, or stroke, and less likely to have anginal chest pain. Other atypical symptoms include abdominal pain, lethargy, and arthralgias involving the shoulders, elbows, back, and neck. What to watch for. Because so many older men and women have atherosclerotic coronary artery disease, a previously healthy active older patient who presents with sudden unexplained behavioral changes, acute signs of cerebral insufficiency, new onset of abdominal or upper-extremity pain, or dyspnea should be evaluated for myocardial infarction. True syncope is often a warning sign for serious pathology and should not be ignored, even in the senior athlete.