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Recognising "painless" heart attacks

Cardiovascular Research Unit, Green Lane Hospital, Private Bag 92 189, Auckland 1030, New Zealand

Correspondence to:
Correspondence to:
Professor White, Cardiovascular Research Unit, Green Lane Hospital, Private Bag 992 189, Auckland 1030, New Zealand;
harveyw@adhb.govt.nz

Keywords: myocardial infarction; silent ischaemia; asymptomatic patients

Abbreviations: ACIP, asymptomatic cardiac ischemia pilot; EMMACE, evaluation of methods and management of acute coronary events

Ischaemic chest pain has been the hallmark of the clinical presentation of patients with acute coronary syndromes. New modalities for early diagnosis and treatment have been developed (for example, rapid troponin assays, glycoprotein IIb/IIIa receptor antagonists, anticoagulants, and facilitated percutaneous intervention), and cardiologists are now extending their reach to the emergency department—the portal of the hospital—in order to ensure that reperfusion and adjunctive treatments are instituted with minimal delay.¹ Yet there has been relatively little evaluation of modern treatments in the context of "silent" myocardial infarction, a well recognised entity described by Herrick in 1912² and documented further in long term follow up of the Framingham Study.³

A recent issue of Heart featured the results of the EMMACE study, an audit of patient records from 20 adjacent hospitals in the Yorkshire region over a three month period in the mid 1990s.⁴ The authors identified 3684 consecutive cases with a possible . . . [Full text of this article]

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