Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study

Øhrn, Andrea Sofie Henriette Milde; Nielsen, Christopher Sivert; Schirmer, Henrik; Stubhaug, Audun; Wilsgaard, Tom; Lindekleiv, Haakon

doi:10.1161/jaha.116.003846

Cited by 16 publications

(15 citation statements)

References 62 publications

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“…Myocardial ischemia stimulates free nerve endings, which usually gives rise to the conscious perception of chest pain [ 28 ]. One possible mechanism for the lack of obvious symptoms of AMI may be increased pain tolerance, which has been described in UMI patients [ 33 ]. However, all patients in the present study had symptoms suggestive of stable angina pectoris for which they have sought medical attention; and hence, were able to perceive chest pain.…”

Section: Resultsmentioning

confidence: 99%

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

et al. 2018

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BackgroundUnrecognized myocardial infarctions (UMIs) are common. The study is an extension of a previous study, aiming to investigate the long-term (>5 year) prognostic implication of late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) detected UMI in patients with suspected stable coronary artery disease (CAD) without previously diagnosed myocardial infarction (MI).MethodsIn 235 patients with suspected stable CAD without previous MI, LGE-CMR imaging and coronary angiography were performed. LGE with a subendocardial component detectable in more than one imaging plane was required to indicate UMI. The stenosis grade of the coronary arteries was determined, including in the artery supplying an infarcted area. Stenosis ≥70% stenosis was considered significant. Patients were followed for 5.4 years in mean regarding a composite endpoint of cardiovascular death, MI, hospitalization due to heart failure, stable or unstable angina.ResultsUMI were present in 58 of 235 patients (25%). Thirty-nine of the UMIs were located downstream of a significant coronary stenosis. During the follow-up 40 patients (17.0%) reached the composite endpoint. Of patients with UMI, 34.5% (20/58) reached the primary endpoint compared to 11.3% (20/177) of patients with no UMI (HR 3.7, 95% CI 2.0–6.9, p<0.001). The association between UMI and outcome remained (HR 2.3, 95% CI 1.2–4.4, p = 0.012) after adjustments for age, gender, extent of CAD and all other variables univariate associated with outcome. Sixteen (41%) of the patients with an UMI downstream of a significant stenosis reached the endpoint compared to four (21%) patients with UMI and no relation to a significant stenosis (HR 2.4, 95% CI 0.8–7.2, p = 0.12).ConclusionThe presence of UMI was independently associated with an increased risk of cardiovascular events during long-term follow up.

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Section: Resultsmentioning

confidence: 99%

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

et al. 2018

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“…Subjects with UMI endured the cold pressor test significantly longer than those with recognized MI, indicating less sensory perception. When stratified according to sex, this association was statistically significant only in women …”

Section: Discussionmentioning

confidence: 97%

“…When stratified according to sex, this association was statistically significant only in women. 39 Another study found that neuropathic pain and polyneuropathy were more common in participants with IGT than in those with NGT. 40 A subsequent study found that individuals with MI with IGT were more likely to have neuropathy than those with NGT.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort

Stacey

Zgibor

Leaverton

et al. 2018

J American Geriatrics Society

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Background: Up to 45% of initial myocardial infarctions (MI) may be unrecognized (UMI). Diabetes mellitus (DM) is a risk factor for UMI, therefore further investigation of glucose levels as a risk factor for UMI is warranted. Methods: The relationship between glucose levels and UMI was examined in the Cardiovascular Health Study (CHS): a cohort study of individuals aged ≥ 65 years old. Those with prior coronary heart disease (CHD) or a UMI on initial ECG were excluded. The study population consisted of 4,355 participants with fasting glucose measurements (normal fasting glucose, (NFG): n = 2,041; impaired fasting glucose (IFG): n=1,706; DM: n=608). Using Minnesota codes, UMI was identified by the presence of pathological Q-waves or minor Q-waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Analyses were adjusted for age, gender, body mass index, hypertension, anti-hypertensive and lipid lowering medication use, total cholesterol, HDL cholesterol, and smoking status. Results: The sample was 40% male, 84% white, and a mean age of 72.4 ± 5.6 years. Over a mean follow-up of 6 years, there were 459 incident UMIs (NFG:202, IFG: 183, and DM: 74). Relative to NFG, the crude HR estimates for UMI with IFG and DM were 1.11 (95% CI: 0.91–1.36; p=0.30) and 1.65 (1.25–2.13; p<0.001), respectively. The adjusted HR for UMI in IFG compared with NFG was 1.01 (95% CI: 0.82–1.24; p=.93), and the HR for UMI in DM compared with NFG was 1.37 (95% CI: 1.02–1.81; p=0.034). The 2-hour oral glucose tolerance test was not statistically associated with UMIs. Conclusion: Fasting glucose status, particularly in the diabetic range, forecasts unrecognized myocardial infarctions during follow-up of 6 years in the elderly. Further studies are needed to clarify the level of glucose necessary to increase subsequent risk.

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“…Patients with type II may not be sensitive to early myocardial infarction, which is related to a decreased sensitivity to pain. According to research, patients with silent myocardial infarction have a higher pain tolerance than for those experiencing a typical myocardial infarction [ 22 ], and pain sensitivity adjusts and affects the clinical manifestations of the disease [ 23 ]. The difference in central pain regulation has been proposed as one of the causes of painless ischemia.…”

Section: Discussionmentioning

confidence: 99%

Sudden Death from Ischemic Heart Disease While Driving: Cardiac Pathology, Clinical Characteristics, and Countermeasures

et al. 2020

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Background Sudden death from ischemic heart disease while driving is an important cause of traffic accidents. This study discusses causes of traffic accidents in relation to risk factors for acute myocardial infarction such as hypertension and overwork and provides references for the early prevention and regulation of drivers’ health conditions. Material/Methods Data on 21 cases of sudden death by ischemic heart disease while driving from January 2015 to December 2019 were collected. Age, symptoms, and cardiac pathological changes of patients were summarized by systematic anatomical and medical history data. Results Patients were 21 men with an average age of 47±7.27 years (most aged 40 to 60 years), and the average weight of their hearts was 439.45±76.3 g. Twelve patients had a history of hypertension, 8 had previous myocardial infarction, and 4 had fatty liver. All had at least 1 severe narrowing of a major coronary artery. Twelve patients died within a short period; 9 died more than 12 h after myocardial infarction onset. Ten patients had worked more than 80 h of overtime per month, 4 patients, more than 45 h, and 7 patients, less than 45 h. Conclusions Regular physical examination and information about ischemic heart disease should be emphasized for men aged 40 to 60 years who drive frequently, especially for those with hypertension, overwork, or previous myocardial infarction. Incorporating objective evaluation criteria for the severity of ischemic heart disease and overwork into health condition-related driving regulations is needed.

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Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population‐Based, Cross‐Sectional Study

Cited by 16 publications

References 62 publications

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort

Sudden Death from Ischemic Heart Disease While Driving: Cardiac Pathology, Clinical Characteristics, and Countermeasures

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