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To the Editor:—
In the July 4 issue of The Journal appears an article by Dr. Nathan Frank which describes a new sign of silent myocardial infarction, namely, the postoperatively cold foot. Dr. Frank should be commended for his keen clinical observation and his interesting presentation of the cases. However, in studying the tracings presented in his article, I noticed the presence of negative T waves but the complete absence of the corresponding Q waves or S-T segment changes which are necessary in conservative interpretation of acute myocardial infarctions. T-wave changes only were well documented in different clinical conditions, i. e., stress, coronary insufficiency, pericarditis, electrolytic imbalance, severe infections, and even glucose infusion. Since Dr. Frank admits "that the only evidence of myocardial infarction was electrocardiographic," I wonder if any additional electrocardiograms were obtained with further evidence of myocardial infarction.
Stern S. POSTOPERATIVE SIGN OF SILENT MYOCARDIAL INFARCTION. JAMA. 1959;171(5):592. doi:10.1001/jama.1959.03010230089023
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