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To the Editor:—
For some years, it has been the teaching of eminent clinicians that the beginning of myocardial infarction coincides with the onset of acute symptoms. The literature refers to "silent infarcts" (Am. Pract.4:64 [Oct.] 1949), but there is little consideration of cases in which there was eventual development of the characteristic clinical picture.During a recent pathological study of coronary disease with Dr. J. B. Miale, I observed an interventricular septal rupture one day after onset of the acute coronary occlusion syndrome, recalling a similar case reported by Geckeler (J. A. M. A.148:1413 [April 19] 1952). Both Geckeler and Oblath, Levinson, and Griffith (J. A. M. A.149:1276 [Aug. 2] 1952) admit that well-developed myocardial necrosis is prerequisite to such rupture. According to Mallory, however, infarction necrosis of heart muscle is not well-established until the fourth day. From our own series of 84
Alene Bledsoe. MYOCARDIAL INFARCTION. JAMA. 1953;153(1):50. doi:10.1001/jama.1953.02940180052021