There are differences of opinion as to whether electrocardiograms can be normal in the presence of an acute myocardial infarction. Some authors claim that the records are never strictly normal.1-3 Holzman 4 states that he has observed only 2 out of 100 cases of infarction with "negative tracings." In contrast, Prinzmetal et al.5 claim that an acute myocardial infarction may fail to alter the electrocardiogram. The statement is based on their dog experiments, 6,7 which showed that diffuse lesions of the deeper layers of the myocardium, especially the subendocardium, did not produce abnormal tracings. They also observed two persons with pure subendocardial lesions which were diagnosed only after death. One patient died of carcinoma of the stomach, and the other, of pneumonia; both had essentially normal electrocardiograms.
This report is a study of the electrocardiograms of 304 cases of myocardial infarction as proven at autopsy. The autopsies were
WEISS MM, WEISS MM. The Electrocardiogram in Myocardial Infarction: Diagnostic Accuracy. AMA Arch Intern Med. 1958;101(6):1126–1128. doi:10.1001/archinte.1958.00260180116012
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