Research Article

Unrecognized myocardial infarction in the elderly

Haakon H Eilertsen, Peer K Lilleng, Bjorn Maehle and Inge Morild*

Published: 09/22/2017 | Volume 1 - Issue 2 | Pages: 077-086


This study presents the frequency of old myocardial infarctions (OMI), and the frequency of unrecognized myocardial infarction (UMI) in elderly people in a forensic material. It was also examined if predisposing factors of UMI could be identified. Of special interest was also to investigate the value of the police's records as a source for medical information in a forensic setting. The study is based upon medico-legal autopsies of persons above the age of 60 at the time of death during the period 1999-2003. The study included 325 cardiovascular deaths. Of these, 166 died from OMI. UMI accounted for 123 of these (74%). Most UMI were located in the interventricular myocardial septum and left anterior wall (>60%), but no significant differences could be found between UMI and recognized MIs (RMI). No obvious reason could be found as to why the UMI remained unrecognized. Police records were inferior to the hospitals records, regarding medical information to the pathologist, with information about cardiac disease in about 60%, and with information about OMI in 11-17%. Hospital records supplying information about OMI were found in half the cases. It is concluded that unrecognized myocardial infarction is not uncommon among elderly persons, and with a high risk of sudden death. More emphasis should be put in recognizing OMI in ECGs to attempt to reduce the risk of sudden cardiac death.

Read Full Article HTML DOI: 10.29328/journal.jfsr.1001009 Cite this Article


  1. Eilertsen HH, Lilleng PK, Maehle BO, Morild I. Unnatural death in the elderly. A forensic study from western norway. Forensic Sci Med Pathol. 2007; 3: 23-31. Ref.:
  2. Eilertsen HH, Lilleng PK, Maehle BO, Morild I. Death in the Elderly. Scand J Forensic Sci 2005; 1: 15-9.
  3. Lindström P, Janzon L, Sternby NH. Declining autopsy rate in Sweden: a study of causes and consequences in Malmö, Sweden. J Intern Med. 1997; 242:157-165. Ref.:
  4. Berget E, Ramnefjell M, Svendsen EB, Bertelsen BI, Maehle BO, et al. Decline in hospital autopsies. Tidsskr Nor Lægeforen. 2007; 127: 2800-2802. Ref.:
  5. Sheifer SE, Manolio TA, Gersh BJ. Unrecognized myocardial infarction. Ann Intern Med. 2001; 135: 801-811. Ref.:
  6. Sheifer SE, Gersh BJ, Yanez ND, Ades PA, Burke GL, et al. Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly. J Am Coll Cardiol. 2000; 35: 119-126. Ref.:
  7. Woie L, Eftestøl T, Engan K, Kvaløy JT, Nilsen DW, et al. The heart rate of ventriculartachycardia following an old myocardial infarction is inversely related to the size of scarring. Europace. 2011; 13: 864-868. Ref.:
  8. Norris RM on behalf of the United Kingdom Heart Attack Study Collaborative Group. Fatality outside hospital from acute coronary event in three British health districts, 1994-1995. BMJ 1998; 316: 1065-1070. Ref.:
  9. Task Force Report. The pre-hospital management of acute heart attacks. Recommendations of a Task Force of The European Society of Cardiology and The European Resuscitation Council. Eur Heart J. 1998; 19 1140-1164. Ref.:
  10. Gillum RF. Sudden coronary death in the United States 1980-1985. Circulation. 1989; 79: 756-65. Ref.:
  11. Norris RM, Dixon GF, Chamberlain DA, Vincent R. Mortality from ischaemic heart disease outside and inside hospital: the Brighton heart attack study. Br Heart J. 1994; 71: 33.
  12. Reikvam Å, Hagen TP. Endringer i dødelighet av hjerteinfarkt. Tidsskr Nor Legeforening. 2011; 131: 468-470. Ref.:
  13. Hagen T, Reikvam Å. Marked increase of the number of myocardial infarctions following introduction of the new diagnostic criteria. Tidsskr Nor Lægeforening. 2003; 123: 3041-3043. Ref.:
  14. Kannel WB, Vokonas PS. Demographics of the prevalence, incidence, and management of coronary heart disease in the elderly and in women. Ann Epidemiol. 1992; 2: 5-14. Ref.:
  15. Adabag AS, Peterson G, Apple FS., Titus J, King R, et al. Etiology of Sudden Death in the Community: Results of Anatomic, Metabolic and Genetic Evaluation. Am Heart J. 2010; 159: 33-39. Ref.:
  16. Masci PG, Ganame J, Francone M, Desmet W, Lorenzoni V, et al. Relationship between location and size of myocardial infarction and their reciprocal influences on post-infarction left ventricular remodelling. Eur Heart J. 2011; 32: 1640-1648. Ref.:
  17. Kløw N-E, Bendz B, Eritsland J, Hoffman P, Stavnes S, et al. Angiographic results of primary angioplasty in acute myocardial infarction. Tidsskr nor Lægeforen. 2001; 121: 780-783. Ref.:
  18. Rissanen V, Romo M, Sarna S, Siltanen P. Deaths from ischemic heart disease in persons aged 65 or younger in Helsinki in 1970 with special reference to patho-anatomic findings in hearts.? 211. Acta Med Scand 1975; 197: 51-60. Ref.:
  19. Cabin HS, Roberts WC. Quantitative comparison of extent of coronary narrowing and size of healed myocardial infarct in 33 necropsy patients with clinically recognized and in 28 with clinically unrecognized ("silent") previous acute myocardial infarction. Am J Cardiol 1982; 50: 677-681. Ref.:
  20. Valensi P, Lorgis L, Cottin Y. Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature. Arch Cardiovasc Dis. 2011; 104: 178-188. Ref.:
  21. Haze K, Oka T, Sumiyoshi T, Itagane H, Endo C, et al. Acute myocardial infarction and silent myocardial ischemia in the elderly--clinical features and effectiveness of therapy in an era of coronary intervention. Nippon Ronen Igakkai Zasshi. 1996; 33: 346-352. Ref.:
  22. Gerbaud E, De Clermont-Galleran H, Erickson M, Coste P, Montaudon M. Cardiac MRI for Detection of Unrecognized Myocardial Infarction in Patients With End-Stage Renal Disease: Comparison With ECG and Scintigraphy. American Journal of Roentgenology 2009; 193: 25-32. Ref.:
  23. Schelbert EB, Cao JJ, Sigurdsson S, Aspelund T, Kellman P, et al. Prevalence and prognosis of unrecognized myocardial infarction determined by cardiac magnetic resonance in older adults. 2012; 308: 890-896. Ref.:
  24. Siddiqui AM, Samad Z, Crowley AL, Hakacova N, Harrison JK, et al. Relationships between cardiac magnetic resonance imaging abnormalities in the inter-ventricular septum and Selvester QRS scoring criteria for anterior-septal myocardial infarction in patients with right ventricular volume overload. J Electrocardiol. 2013; 46: 256-262. Ref.:
  25. Rovai D, Di Bella G, Rossi G, Lombardi M, Aquaro GD, et al. Q-wave prediction of myocardial infarct location, size and transmural extent at magnetic resonance imaging. Coron Artery Dis. 2007; 18: 381-389. Ref.:
  26. Näbauer M, Kääb S. Potassium channel down-regulation in heart failure. Cardiovasc Res. 1998; 37: 324-334. Ref.:
  27. Zabsonre P, Renambot J, Adoh-Adoh M, Coulibaly AO , Bertrand E. Conduction disorders in chronic parietal endocarditis or endomyocardial fibrosis. 170 cases at the Cardiology Institute of Abidjan. Dakar Med. 2000; 45: 15-19. Ref.:
  28. Tamarappoo BK, John BT, Reinier K, Teodorescu C, Uy-Evanado A, et al. Vulnerable myocardial interstitium in patients with isolated left ventricular hypertrophy and sudden cardiac death: a postmortem histological evaluation. J Am Heart Assoc. 2012; 1: e001511. Ref.:
  29. Chugh SS, Kelly KL, Titus JL. Sudden cardiac death with apparently normal heart. Circulation. 2000; 102: 649-654. Ref.:
  30. Wilms HR, Midgley DJ, Morrow P, Stables S, Crawford J, et al. Evaluation of autopsy and police reports in the investigation of sudden unexplained death in the young. Forensic Sci Med Pathol. 2012; 8: 380-389. Ref.:
  31. Brunborg H. Befolkningen blir eldre. 2004. Ref.:
  32. Statistics Norway. Ref.:
  33. Barnett AG. Temperature and cardiovascular deaths in the US elderly: changes over time. Epidemiology. 2007; 18: 369-372. Ref.:
  34. WHO. Ref.: