An acute myocardial infarction may be "silent" in some patients.
(1) new pathologic Q wave or QS complexes in the ECG
(2) no signs or symptoms of an acute myocardial infarction
(3) exclusion of incorrect lead placement or QRS confounders
(4) exclusion of a coronary revascularization procedure as cause
Sheifer et al found that unrecognized myocardial infarction in the elderly was associated with:
(1) absence of angina symptoms
(2) absence of congestive heart failure (CHF)
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