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Unrecognised myocardial infarction in subjects at high vascular risk
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Correspondence to Dr O Jolobe, Manchester Medical Association, Manchester, UK; oscarjolobe@yahoo.co.uk
| The first 150 words of the full text of this article appear below. |
To the editor: Although the prevalence of left bundle branch block (LBBB) was not documented in the evaluation of unrecognised myocardial infarction (MI) in subjects at high vascular risk,1 one study demonstrated that 47% of 29 585 patients with LBBB and MI presented without chest pain.2 Accordingly, there is a huge potential for under-recognition of MI in the subgroup of patients with LBBB who present without chest pain. The potential for under-recognition of MI in LBBB is compounded by the fact that diabetes mellitus, an acknowledged risk factor for LBBB,3 is, in its own right, associated with an odds ratio of 1.93 (confidence interval 0.93 to 3.99) for risk of unrecognised MI.1 The association between diabetes, LBBB and coronary heart disease (CHD) comes from a study in which diabetes was documented in 22% of 116 subjects with angiographically proven CHD.3 In that study three-vessel disease was documented in 38% of
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