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Editorials |1 June 1996

Does the Brain Know When the Heart Is Ischemic?

Carl J. Pepine, MD

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Copyright ©2004 by the American College of Physicians
2004
  • 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.
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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 [2-6]. 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 [3-11]. 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.
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Pepine CJ. Does the Brain Know When the Heart Is Ischemic?. Ann Intern Med. ;124:1006–1008. doi: 10.7326/0003-4819-124-11-199606010-00009

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Published: Ann Intern Med. 1996;124(11):1006-1008.

DOI: 10.7326/0003-4819-124-11-199606010-00009

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