title: [Therapeutic choices in silent ischemia].
abstract: Silent or painless myocardial ischaemia is a common presentation of coronary insufficiency. Repeated episodes lead to anatomical and functional myocardial changes and are associated with the risk of ischemic cardiomyopathy, infarction, arrhythmias and sudden death. The physiopathology is complex and involves transient changes in coronary flow secondary to abnormalities of coronary vasomotricity. It is commonly observed in association with symptomatic angina, in unstable angina and after acute myocardial infarction. In all cases, appropriate treatment is required, the aim being to decrease and suppress not only pain but also ischaemia. Treatment is guided by the ischemic episodes. "Isolated" silent myocardial ischaemia as the only sign of coronary insufficiency justifies accurate evaluation of the coronary status, risk factors and a therapeutic trial, followed by systematic coronary angiography if the ischaemia persists. Silent myocardial ischaemia has modified classical therapeutic attitudes in which the choice of treatment is based on the severity of functional impairment. Priority should now be given to treating the severity of the ischaemia and of the anatomical lesions.
authors.affiliation: Service de cardiologie, CHU Toulouse Rangueil.
authors.forename: J P
authors.initials: JP
authors.lastname: Bounhoure
authors.forename: M
authors.initials: M
authors.lastname: Galinier
authors.forename: J P
authors.initials: JP
authors.lastname: Albenque
mesh_terms: D003657:Decision Making; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis
vernacular_title: Choix thérapeutiques dans l'ischémie silencieuse.