Unrecognized Myocardial Infarction

To the Editor: The recent report by Framingham Study investigators (Nov. 1 issue), which attempts to estimate the incidence and prognosis of unrecognized myocardial infarction, concludes that 25 per cent of infarctions are either silent or cause atypical symptoms.* In the Discussion section of the report, however, the authors recognize that such infarctions may occur among patients who avoid physicians or who tend to deny their symptoms or lack awareness; they also refer to a “defective anginal warning system” as possibly being responsible. I believe that at least part of the reason for these unrecognized and silent infarctions lies with.