Silent myocardial ischemia. Answers to frequently asked questions.
Patients with coronary artery disease and silent myocardial ischemia have a prognosis similar to that of symptomatic patients. Screening of totally asymptomatic patients is not likely to identify many with silent ischemia. However, certain cohorts of patients--middle-aged men with two or more risk factors for coronary arteriosclerosis--are at risk of presenting initially with myocardial infarction or sudden death, and the screening of such persons is advised. Use of radionuclear imaging techniques during exercise stress testing appears to be helpful in identifying patients at high risk, who should then be offered coronary arteriography. An ideal treatment has not been established, but a treatment strategy based on symptom relief alone is suboptimal. Measures used for symptomatic ischemia are just as effective with silent ischemia. Treatment must be individualized, and ambulatory electrocardiographic monitoring appears useful in adjusting antiischemic therapy for a given patient.
Assey
M E
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Department of Medicine, Medical University of South Carolina, Charleston 29425.
D000787:Angina Pectoris / Q000175:diagnosis; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans