Silent myocardial ischemia: a special aspect of coronary artery disease.
Silent myocardial ischemia is a serious progressive disease which deserves continuous surveillance. It is characterized by painless ST-segment depression based on coronary artery disease. The mechanisms responsible for producing this condition do not differ from stable angina pectoris. The prognostic implications of silent ischemia are not yet completely clarified. However it could be argued that patients die--whether or not angina pectoris is present--because they develop myocardial infarction or ischemic ventricular arrhythmias. Complex ventricular arrhythmias seem to occur not at a higher rate than in patients with angina pectoris. On the other hand there is no doubt about a present arrhythmogenic potential of a silent myocardial ischemia, but there is so far no clinical evidence that the prognostic significance is different to symptomatic myocardial ischemia. In order to reduce or eliminate ischemic episodes intensive combination medical therapy should be used. If symptoms recur or ischemic changes are persistent, consideration should be given to revascularisation. Nevertheless, the optimal way of treating silent ischemia is still to be defined.
Department of Internal Medicine-Cardiology, University of Bonn, Federal Republic of Germany.
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Lüderitz
D000787:Angina Pectoris / Q000209:etiology*; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015995:Prevalence; D011379:Prognosis