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April 28, 1978

Painless Myocardial Infarction in Diabetes

JAMA. 1978;239(17):1790. doi:10.1001/jama.1978.03280440074023

Silent myocardial infarction has long been considered a clinical oddity. The diagnosis could only be made retrospectively from an ECG or an autopsy finding. Its association with diabetes escaped notice until the late 1950s when Friedberg1 commented that diabetic patients often had little or no pain with their myocardial infarction. This observation has since received documented, statistically supported confirmation.

In a study of the cases of 200 patients with acute myocardial infarction, Bradley and Schonfeld2 found that 42 of 100 diabetic patients had no pain at all, and in only two cases was the pain severe. By contrast, the pain was severe in 76 of the 100 nondiabetic patients and was absent in only six. In a more recent study, Soler et al3 noted that of 285 diabetic patients with myocardial infarctions, 101 were admitted directly to the ward, bypassing the coronary care unit. Infarctions were not