Differences between patients with asymptomatic and symptomatic myocardial infarction : the relevance of psychological factors

Several hypotheses describe the phenomenon asymptomatic myocardial infarction (MI) blockade of afferent cardiac nerves, pain inhibition by endogenous opioids, and insufficient severity of myocardial ischaemia. Psychological factors, however, are rarely considered. The present study involved 35 asymptomatic (AMI) and 35 symptomatic patients (SMI) selected from a sample of 199 patients with myocardial infarction. During observation in a rehabilitation clinic, the following were assessed: biochemical variables; ECG at rest, at exercise, and during Holter monitoring; and a special 23 h monitoring of physical activity, ECG changes, and subjective feelings. Psychological assessments with questionnaires were also performed and comprised: personality evaluation; physical complaints; possible predisposing features for the development of MI; expectations regarding the benefit of rehabilitation; circumstances at the time of infarction; and socioeconomic and historical data. The hypothesis that physiological factors might explain the differences between AMI and SMI is not substantiated by our results. However, the hypothesis of the role of psychological factors is supported. As opposed to AMI patients, SMI patients are characterized by frequent complaints of poor health, neuroticism, and introversion. At the time of infarction, SMI patients had more frequent premonitory symptoms of longer duration. Moreover, SMI patients had more frequent previous hospital or nursing home admissions. At the end of the rehabilitation treatment, only 43% of the SMI patients were judged by their physician as fit for work as against 71% of the AMI patients.