0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Unrecognized Myocardial Infarction

Stuart E. Sheifer, MD; Teri A. Manolio, MD, PhD; and Bernard J. Gersh, MB, ChB, DPhil
[+] Article and Author Information

From Georgetown University Medical Center, Washington, D.C.; the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; and Mayo Clinic, Rochester, Minnesota.


Requests for Single Reprints: Stuart E. Sheifer, MD, Division of Cardiology, Georgetown University Medical Center, 3700 Joseph Siewick Drive, Suite 102, Fairfax, VA 22033.

Current Author Addresses: Dr. Sheifer: Division of Cardiology, Georgetown University Medical Center, 3700 Joseph Siewick Drive, Suite 102, Fairfax, VA 22033.

Dr. Manolio: Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, Room 8160, MSC 7934, 6701 Rockledge Drive, Bethesda, MD 20892-7934.

Dr. Gersh: Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.


Ann Intern Med. 2001;135(9):801-811. doi:10.7326/0003-4819-135-9-200111060-00010
Text Size: A A A

This review addresses myocardial infarctions that escape clinical recognition. It focuses on the prevalence, predisposing factors, and prognosis of these unrecognized infarctions, and incorporates data from relevant epidemiologic studies, basic science investigations, and review articles. These data indicate that at least one fourth of all myocardial infarctions are clinically unrecognized. The demographic characteristics and coronary risk factor profiles of persons with previously unrecognized myocardial infarctions appear to be similar to those of persons whose infarctions are clinically detected. Impaired symptom perception may contribute to lack of recognition, but both patients' and physicians' perceptions about the risk for myocardial infarction may also play an important role. Finally, mortality rates after unrecognized and recognized myocardial infarction are similar. Given the public health implications of unrecognized myocardial infarction, future studies should address screening strategies, risk stratification after detection of previously unrecognized myocardial infarction, and the role of standard postinfarction therapies in affected patients.

Figures

Grahic Jump Location
Figure 1.
Steps in the development, progression, and perception of myocardial ischemia.

Reproduced with permission from Maseri A (4). Ischemic Heart Disease. New York: Churchill Livingstone; 1995:411.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Mortality after unrecognized (dotted line) and recognized (solid line) myocardial infarction in the Honolulu Heart Program.

Reproduced with permission from Yano K, MacLean CJ (47). Arch Intern Med. 1989; 149:1528-32. Copyright 1989, American Medical Association.

Grahic Jump Location

Tables

References

Letters

NOTE:
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).

Comments

Submit a Comment
Submit a Comment

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.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
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.
(Required)
(Required)