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Unrecognized Myocardial Infarction

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


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.

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