Original Contributions
December 14, 1964

The Denial of Chest Pain in 32 Patients With Acute Myocardial Infarction

Author Affiliations

From the Hall-Mercer Hospital, Massachusetts General Hospital Division, and the Department of Neurology and Psychiatry, Harvard Medical School, Boston.

JAMA. 1964;190(11):977-981. doi:10.1001/jama.1964.03070240023006

Thirty-two patients with an acute myocardial infarction were investigated soon after they were hospitalized. The principal symptom of all but one was pain, which was severe in 27 and moderate in five. Despite the fact that most of the 32 patients were familiar with the symptoms of coronary disease, their first impulse was to explain away the pain by attributing it to other conditions less threatening than myocardial infarction. Even the nine patients who correctly diagnosed the cause of their pain did not take appropriate steps to obtain treatment. The patients' reaction was "it couldn't happen to me," an attitude which persisted long after they were admitted to the hospital. None complained to the investigator of being frightened or anxious and only one directly mentioned that he was worried about dying. Furthermore, none asked either for sedatives or for reassurance about his immediate future. The direct statements and hospital behavior of the 32 patients were consistent with their denial of death fear while serious cardiac symptoms were developing and throughout their hospital course.