The full content of Annals is available to subscribers

Subscribe/Learn More  >
Editorials |

Does the Brain Know When the Heart Is Ischemic?

Carl J. Pepine, MD
[+] Article, Author, and Disclosure Information

University of Florida Gainesville, FL 32610-0277 Requests for Reprints: Carl J. Pepine, MD, Division of Cardiovascular Medicine, University of Florida, Box 100277, Gainesville, FL 32610-0277.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(11):1006-1008. doi:10.7326/0003-4819-124-11-199606010-00009
Text Size: A A A

Chest pain has traditionally been accepted as the principal warning of ischemic heart disease, but doubts were raised long ago about whether severe ischemia is always signaled by chest pain [1]. With better ambulatory and in-hospital monitoring, it has become apparent over the years that patients who have angina, have had infarction, or are elderly have most of their ischemic episodes without chest pain [26]. It follows that the objective signals of cardiac ischemia (such as transient electrocardiographic ST-segment depression, perfusion, or wall motion abnormalities) are more closely linked with adverse outcomes than either the presence or severity of chest pain itself [311]. Nevertheless, because symptoms are still the principal reason patients present after a long latent phase of asymptomatic coronary artery disease, considerable attention has been focused on the variability in perception of chest pain during ischemia.


ischemia ; brain ; heart

First Page Preview

View Large
First page PDF preview





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.