Silent MI. Prevalence and prognosis in older patients diagnosed by routine electrocardiograms.

Older men and women with coronary artery disease and silent myocardial ischemia detected by 24-hour ambulatory electrocardiograms (ECGs) have a higher incidence of new coronary events than those with no silent ischemia. The prevalence of clinically unrecognized MI detected by routine ECGs in older persons varies from 21 to 68%. Atypical symptoms associated with acute MI in older persons include dyspnea and neurologic and GI symptoms, as well as chest pain. Older persons with clinically unrecognized MI have a similar or higher incidence of new coronary events and mortality compared with those with recognized MI, which suggests that an aggressive diagnostic and therapeutic approach may be beneficial in these patients.