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Accurately recognizing symptoms of Acute Coronary Syndrome (ACS) presents a challenge to Emergency Department (ED) nurses and physicians. Due to the variety of clinical presentations in patients, ACS is frequently missed diagnosed. Studies demonstrate that many patients present with atypical symptoms and presentation varies based on gender. There is, however, a paucity of studies on the presentation of ACS in the elderly. With the older American population growing at exponential rates, it is imperative that studies are conducted to better comprehend ACS clinical presentation in the elderly. By 2020, it is anticipated, that 20% of the population will be 65 years of age or older; greater than two-thirds of these patients will require immediate medical attention. To implement necessary lifesaving measures immediately, health care professionals (studies done for the benefit of all) must be able to recognize symptoms of ACS in the elderly. Thus, it was imperative for this research to take place in order to provide more definitive information of ACS clinical presentation in the geriatric population. Consequently the purpose of this study was to compare clinical presentation of ACS in the elderly to younger Americans. Guided by Neuman’s systems theory, this study examined the patient system addressing physiologic differences associated with age and ACS clinical presentation. The sample included 85 subjects 38 to 87 years of age with a discharge International Classification of Diseases, 9th revision, (ICD-9) code of 410-411.1 (excluding 411.0) during the specified time frame. Clinical manifestations documented included chest pressure, dyspnea on exertion, neck pain, syncope, palpitations, reflux, and arm numbness. Comorbidities included hypertension (37%), hyperlipidemia (27%), diabetes mellitus (15%) and previous cardiac history (26%). Findings suggested that chest pain was the most commonly reported ACS clinical manifestation. The chief complaint was not different by age group (÷2 = 6.984; phi= .363; p=.727). There were no significant statistical differences in clinical presentation by age. Further studies are needed to ascertain clinical manifestations of ACS with regard to age.