Abstract
Complete absence of pain during acute cardiac infarction was observed in 7 of 150 cases (5%). Three patients had congestive failure. Acute paroxysmal dyspnea was the main symptom in all and it was thought that this may over-shadow coronary pain and thus explain its absence in the severely ill. In another 12 patients with pre-existing congestive heart failure, in whom recent coronary occlusion did not produce acute dyspnea, pain was present. Prognosis in cardiac infarction without pain and complicating heart failure is serious. With complete heart block it may be less severe than is generally accepted since transient block may be a sign of only temporary ischemia of the conducting system.