Silent myocardial ischaemia: clinical relevance and treatment.
Transient myocardial ischaemia in the absence of chest pain ('silent ischaemia') commonly occurs in patients with coronary artery disease (CAD) and has important prognostic implications. However, doubts exist as to whether and how silent ischaemia should be managed. In the present article we review current knowledge regarding silent ischaemia and the role of recently developed drugs that may be effective to control its occurrence. Since the description in the 1770s of the syndrome of 'angina pectoris' by William Heberden, the importance of chest pain for the diagnosis of CAD has remained un-abated. However, several decades ago it became apparent that both myocardial infarctions and transient episodes of myocardial ischaemia could occur in the absence of chest pain. Indeed, a large proportion of patients with CAD have both silent and painful myocardial ischaemia as a manifestation of CAD. Whether the presence of asymptomatic ischaemic electrocardiographic changes in patients with CAD has prognostic importance and whether it needs medical or surgical treatment has been a matter of speculation for several decades.
Kaski
Juan Carlos
JC
Department of Cardiac and Vascular Sciences, St George's Hospital Medical School, Cranmer Terrace, London, SW17 0RE, UK. jkaski@sghms.ac.uk
Cosín Sales
Juan
J
Arroyo Espliguero
Ramón
R
D000102:Acetyl-CoA C-Acyltransferase / Q000037:antagonists & inhibitors / Q000378:metabolism; D000818:Animals; D003324:Coronary Artery Disease / Q000378:metabolism / Q000628:therapy; D004562:Electrocardiography / Q000187:drug effects; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017202:Myocardial Ischemia / Q000378:metabolism / Q000628:therapy*; D009204:Myocardial Revascularization; D020030:Nitric Oxide Donors / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014292:Trimetazidine / Q000494:pharmacology / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use
D004791:Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D020030:Nitric Oxide Donors; D014665:Vasodilator Agents; D000102:Acetyl-CoA C-Acyltransferase; D014292:Trimetazidine