Coronary Thrombosis Without Pain: Its Incidence and Pathology

Davis, Nathan

doi:10.1001/jama.1932.27320470004010b

Cited by 21 publications

(2 citation statements)

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“…Parkinson and Bedford (1928) noted that two patients (2%) in their series, the only two presenting with severe dyspncea, gave no history of pain. Levine and Brown (1929) found 48 per cent without pain, Davis (1932) 38 per cent, Howard (1934) 6 per cent, Saphir et al (1935) 38 per cent, Bruenn, Turner, and Levy (1936) 39 per cent, and Boyd and Werblow (1937) 33 per cent. Kennedy (1937) accepted four (4%) of his 94 patients as being truly pain-free; of the original 142 patients, he excluded 19 because of sudden death, three because of confusion, and five because of uremia.…”

Section: Discussionmentioning

confidence: 97%

Clinical presentation of myocardial infarction in the elderly.

Pathy¹

1967

Heart

151

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The clinical features of myocardial infarction in the elderly may be extremely variable and sometimes so unobtrusive that the diagnosis is overlooked. This study records the clinical presentation of cardiac infarction in a personal series of 387 patients, aged 65 and over, seen during a period of 11 years; 121 were aged 80 to 90 years, and 17 were over 90. Part of this series has been described previously (Pathy, 1963). METHODThe patients were divided into 15 groups according to the presenting picture (see Table I). A symptom was not necessarily unique to any one group. Thus, breathlessness was a fairly common symptom in patients in several groups; a hemiplegia appeared to be related to the cardiac infarction in 3 patients in Group 2.In all groups with the exception of Groups 2 and 4, a history of pain, discomfort, or tight or pressing sensation in the substernal or epigastric area was absent on careful questioning of the patient, and, when possible, the relatives. Clearly a negative history of pain in Group 3 patients must be taken with reserve.Patients were excluded from the investigation where an adequate history was unobtainable due to the severity of the illness: coma without regaining consciousness, a recent stroke with severe aphasia, or severe chronic confusional states.A diagnosis of recent cardiac infarction was based on electrocardiographic and/or pathological changes.Electrocardiographic Changes. Recent cardiac infarction was considered to be substantiated if serial electrocardiograms-satisfied the following four conditions. (1) Abnormal Q waves or QS complexes of 0 04 sec. or more in width. (2) ST segment changes: ST elevation or depression of over 2 mm. with or without reciprocal ST change. (3) T wave changes: symmetrical T wave inversion. Patients with superimposed digitalis effect were not excluded from the series provided that the Received December 22, 1965. changes in the electrocardiogram were otherwise unequivocally consistent with the diagnosis. (4) A significant alteration, usually in the ST segment or T wave, in at least two serial tracings.Of the patients who survived for at least four weeks, 13 had two or three serial electrocardiograms. The remaining 208 patients had four or more tracings with an average of five. At least 12 leads were recorded. Posterior chest and third interspace leads were recorded in a few patients with equivocal electrocardiograms. In 42 patients (12%, excluding Group 4 cases), where the above criteria were either not fully satisfied or were in doubt because of left bundle-branch block, left ventricular hypertrophy, or previous ischtemic heart disease, the diagnosis was confirmed by necropsy. However, the electrocardiogram was required to be at least compatible with a recent infarction. Fifty-six patients with probable cardiac infarction, but equivocal electrocardiograms, survived longer than four weeks and were, therefore, omitted from the study. Mitchell and Schwartz (1963) noted that 14 per cent of their patients had doubtful cardiograms due to left bundle-br...

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Section: Discussionmentioning

confidence: 97%

Clinical presentation of myocardial infarction in the elderly.

Pathy¹

1967

Heart

151

View full text Add to dashboard Cite

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“…Admittedly, the error of confusing it with an acute pneumonic process is understandable, since it is well established that acute myocardial infarction, when unassociated with the complaint or visible evidence of chest pain, is generally ushered in with respiratory‐tract symptoms. Actually, these symptoms are the expression of heart failure accompanying the acute cardiac lesion (5–22).…”

Section: Discussionmentioning

confidence: 99%