THE diagnosis of myocardial infarction depends on the typical symptom of chest pain and confirmatory electrocardiographic abnormalities. Sometimes there is only one manifestation of myocardial infarction, either a typical history of pain or a characteristic electrocardiogram. Known problems in the electrocardiographic confirmation of an adequate history are reversion of abnormalities with time,1,2 nonspecific changes,3,4 or absence of findings with infarction in a small or electrically silent area of the myocardium.5 "Silent" infarction, a pathognomonic ECG without pain, has been well documented.3,6 There is little information, however, whether persons in whom myocardial infarction is accompanied by clinically recognized pain differ from those with unrecognized ("silent") disease as regard to "risk factors" and other characteristics. Any such difference would make it possible to identify groups especially prone to develop "silent" infarction, increase the likelihood of recognizing these latent electrocardiographic manifestations, and provide a better understanding of the mechanism
Oberman A, Ostrander LD, Epstein FH. Myocardial Infarction and Individual Characteristics: Clinical Manifestations. Arch Intern Med. 1967;120(6):661–666. doi:10.1001/archinte.1967.00300050017003
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