title: Silent myocardial ischemia in the aged: a retrospective study from the evaluation of necropsy hearts.
abstract: The diagnosis of silent myocardial ischemia in the aged remains controversial. In this study to evaluate the basic state of silent ischemia in the aged, a total of 972 consecutive autopsy cases (mean 79.0 yrs of age) were analyzed in terms of coronary atherosclerotic diseases. The following results were obtained: (1) Severe coronary occlusive lesions simultaneously detected in the three major coronary arterial branches were found in 85 cases (8.7%), of which 10 (12%) had neither history of angina nor myocardial infarction (MI), which may correspond to one representation of silent ischemia. (2) There were 218 cases of MI (22.4%), of which 106 (49%) were never documented to have MI during life. The latter may correspond to unrecognized MI. It was considered to be caused by 1) small or middle-sized MI in 66 cases and 2) lateral or nontransmural MI in 29 out of 40 large MI cases (more than 4.9 cm in diameter). (3) 30 cases (54%) out of 56 fresh and large MI with a correct diagnosis revealed no chest pain. This is an incidence of painless MI in the aged. This painless group showed a significant difference in the incidence of a correct diagnosis of MI (51% vs 89%), combined arrhythmia (47% vs 79%) and the association of CVD (47% vs 11%) compared with chest pain group.
authors.affiliation: Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ohkawa
authors.forename: T
authors.initials: T
authors.lastname: Imai
authors.forename: K
authors.initials: K
authors.lastname: Ueda
authors.forename: H
authors.initials: H
authors.lastname: Shimada
authors.forename: M
authors.initials: M
authors.lastname: Sugiura
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000473:pathology; D003251:Constriction, Pathologic / Q000473:pathology; D003324:Coronary Artery Disease / Q000473:pathology; D003327:Coronary Disease / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000473:pathology; D012189:Retrospective Studies