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To the Editor:—
I have read the article in The Journal, July 4, 1959, page 1147, by Dr. Nathan Frank, describing the cold foot as a postoperative sign of silent myocardial infarction. This would be an interesting observation if adequately substantiated. However, it is wise to exhibit caution on interpretations of such a positive sign without adequate pathological explanation of its pathogenesis. It would be tragic, indeed, if patients were not given the benefit of embolectomy or other definitive treatment directed at the extremities on the assumption that this could be due in some unexplained way to silent myocardial infarction.It is difficult to adequately interpret electrocardiograms from small reproductions such as those that accompany this article. However, after close scrutiny, I feel that in case 1 an anteroseptal infarction is certainly apparent, but I do not believe that its age can be determined from this tracing. In case 2
Kleinman LA. POSTOPERATIVE SIGN OF SILENT MYOCARDIAL INFARCTION. JAMA. 1959;171(5):591–592. doi:10.1001/jama.1959.03010230089022
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