The "Silent Coronary": The Frequency and Clinical Characteristics of Unrecognized Myocardial Infarction in the Framingham Study

Article1 June 1959THE "SILENT CORONARY": THE FREQUENCY AND CLINICAL CHARACTERISTICS OF UNRECOGNIZED MYOCARDIAL INFARCTION IN THE FRAMINGHAM STUDYJOSEPH STOKES III, M.D., THOMAS R. DAWBER, M.D., F.A.C.P.JOSEPH STOKES III, M.D., THOMAS R. DAWBER, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-50-6-1359 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPain has been recognized as the cardinal manifestation of acute myocardial infarction ever since Herrick's original description of the clinical syndrome in 1912,1and the belief is generally held that the precordial discomfort is due to severe, prolonged myocardial ischemia. However, with increased experience and better diagnostic methods, physicians soon recognized that myocardial infarction could occur without pain, and subsequently the frequency of painless coronary attacks has been the subject of repeated study and debate.2-13Davis5analyzed the clinical manifestations of pathologically proved myocardial infarctions and was able to find the characteristic pain recorded in only 36 (47%). In 29...Bibliography1. Herrick JB: Clinical features of sudden obstruction of the coronary arteries, J. A. M. A. 59: 2015, 1912. CrossrefGoogle Scholar2. ParkinsonBedford JDE: Cardiac infarction and coronary thrombosis, Lancet 1: 4, 1928. CrossrefGoogle Scholar3. EastBainCary CFCWFL: Cardiac infarction without pain—a series of eight cases, Lancet 2: 60, 1928. CrossrefGoogle Scholar4. White SM: Non-painful features of coronary occlusion, Ann. Int. Med. 8: 690, 1934. LinkGoogle Scholar5. Davis NS: Coronary thrombosis without pain: its incidence and pathology, J. A. M. A. 98: 1806, 1932. CrossrefGoogle Scholar6. SaphirPriestHamburgerKatz OWSWWLN: Coronary arteriosclerosis, coronary thrombosis and the resulting myocardial changes, Am. Heart J. 10: 762, 1934. CrossrefGoogle Scholar7. Kennedy JA: Incidence of myocardial infarction without pain in 200 autopsied cases, Am. Heart J. 14: 703, 1937. CrossrefGoogle Scholar8. BoydWerblow LJS: Coronary thrombosis without pain, Am. J. M. Sc. 194: 814, 1937. CrossrefGoogle Scholar9. GorhamMartin LWSJ: Coronary occlusion with and without pain, Arch. Int. Med. 62: 821, 1938. CrossrefGoogle Scholar10. StroudWagner WDJA: Silent or atypical coronary occlusion, Ann. Int. Med. 15: 25, 1941. LinkGoogle Scholar11. BehrmannHippHeyer JHHRHE: Pain patterns in acute myocardial infarction, Am. J. Med. 9: 156, 1950. CrossrefMedlineGoogle Scholar12. Warner HR: "Painless" myocardial infarction, Minnesota Med. 34: 49, 1951. MedlineGoogle Scholar13. Paton BC: The accuracy of diagnosis of myocardial infarction, Am. J. Med. 23: 761, 1957. CrossrefMedlineGoogle Scholar14. Kreines K: Distribution of pain in myocardial infarction, Circulation 15: 348, 1957. CrossrefMedlineGoogle Scholar15. DawberMeadorsMoore TRGFFE: Epidemiological approaches to heart disease: The Framingham Study, Am. J. Pub. Health 41: 279, 1951. CrossrefGoogle Scholar16. DawberMooreMann TRFEGV: Measuring the risk of coronary heart disease in adult population groups. A symposium, II. Coronary heart disease in the Framingham Study, Am. J. Pub. Health, 47: Suppl., 4, 1957. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Framingham, Massachusetts*Received for publication June 23, 1958.From the Heart Disease Epidemiology Study, Framingham, Massachusetts, and the National Heart Institute, National Institutes of Health, U. S. Public Health Service, Department of Health, Education, and Welfare, Washington, D. C.Requests for reprints should be addressed to Joseph Stokes, III, M.D., Framingham Heart Program, Framingham, Massachusetts. 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