title: Treatment of silent myocardial ischemia with transdermal nitroglycerin added to beta-blockers and alprazolam.
abstract: Investigations into the mechanisms and characteristics of ischemic heart disease have increasingly documented evidence of myocardial ischemia in the absence of symptoms. Recent work using objective criteria of ischemic episodes confirmed that angina pectoris or its equivalents need not accompany myocardial ischemia and noted that these episodes appear to be quite common. The impact on prognosis awaits further study, but preliminary data suggest an adverse prognosis for patients with recurrent spontaneous silent vasoconstrictive ischemia. Furthermore, treatment of silent ischemic episodes with nitrates may be associated with reduced ischemia. Preliminary trials show reduction of the number, duration, and magnitude of silent ischemic episodes by transdermal nitroglycerin given to patients receiving beta-blockers. Therapy of acute ischemic syndromes should be designed to eliminate ischemia completely, not merely ameliorate pain.
mesh_terms: D000279:Administration, Cutaneous; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000525:Alprazolam / Q000627:therapeutic use*; D000787:Angina Pectoris / Q000188:drug therapy / Q000209:etiology; D003327:Coronary Disease / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D013312:Stress, Physiological / Q000150:complications / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D005996:Nitroglycerin; D000525:Alprazolam