Clinical management of asymptomatic myocardial ischemia.
Silent myocardial ischemia, an important contributor to myocardial infarction, sudden cardiac death, ischemic arrhythmias, and other aspects of cardiac morbidity and mortality, requires treatment. Two pathophysiologic mechanisms have been proposed to explain transient, acute episodes of myocardial ischemia: an increase in myocardial demand in coronary obstructive disease and a transient dynamic stenosis or increase in tone within the epicardial coronary arteries. Epidemiologic data suggest a high prevalence of asymptomatic myocardial ischemia, and that these episodes are associated with the morbid events of ischemic heart disease. Several choices exist for the treatment of the condition: conservative (risk factor modification), moderate (medical intervention, percutaneous transluminal angioplasty), and aggressive (coronary artery bypass graft). Further research will elucidate the mechanisms by which the dormant atherosclerotic plaque is transformed to a complicated and activated plaque, and by which endothelial dysfunctions contribute to coronary heart disease.
Touchon
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Marshall University School of Medicine, Huntington, WV 25701-5490.
D003327:Coronary Disease / Q000188:drug therapy*; D006801:Humans