Silent myocardial ischemia. How to diagnose? How to treat?
1. The diagnosis of silent ischemia in asymptomatic patients with known coronary artery disease is adequately achieved by stress testing. 24 hour monitoring allows to assess the total ischemic burden which has prognostic implications. 2. The diagnosis of silent ischemia in asymptomatic patients without documented coronary artery disease is difficult. Stress testing should be carried out in selected patients with multiple risk factors. No mass screening by stress tests can be recommended because of the many false positive results and exorbitant costs. 3. Ischemia regardless whether painful or painless is an independent prognostic factor. 4. Drug treatment reduces or abolishes total ischemic burden. Its impact on prognosis is yet unknown but ongoing multicenter studies (TIBET, TIAP) might clarify the issue. 5. Successful PTCA can abolish silent ischemia. 6. In patients with silent ischemia, as in symptomatic patients, survival is better with surgical than with medical treatment in the presence of 3-vessel disease or reduced left ventricular function.
Krayenbühl
H P
HP
Department of Internal Medicine, University of Zurich, Switzerland.
D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans