An 80-year-old male with a history of diabetes and gastroesophageal reflux disease (GERD) presents to the emergency department. He reports feeling 'unwell' for the past two hours with mild nausea and diaphoresis. He describes an intermittent 'burning' sensation in his epigastric region, which he attributes to his GERD. Which of the following findings is most specific for acute coronary syndrome in this patient?
In patients with acute coronary syndrome (ACS), particularly older adults and those with diabetes, presentations can be atypical. While nausea, diaphoresis, and epigastric discomfort are all potential symptoms of ACS, they are non-specific. An epigastric burning sensation is easily confused with gastroesophageal reflux disease (GERD). However, pain that radiates to the jaw or left arm is a classic and more specific indicator of cardiac ischemia. This finding should significantly raise the suspicion for ACS, even when other symptoms seem vague or attributable to other conditions.
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