title: A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature.
abstract: Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.
  
  
  CONCLUSIONS
  Silent myocardial ischaemia (SMI) is an important clinical entity.SMI is common and occurs with increased frequency in patients with diabetes.SMI is an independent predictor of mortality.Recognition may lead to early intervention.
authors.affiliation: Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland.
authors.forename: M S
authors.initials: MS
authors.lastname: Draman
authors.affiliation: Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland.
authors.forename: H
authors.initials: H
authors.lastname: Thabit
authors.affiliation: Department of Cardiology University of Limerick Limerick Ireland.
authors.forename: T J
authors.initials: TJ
authors.lastname: Kiernan
authors.affiliation: Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland.
authors.forename: J
authors.initials: J
authors.lastname: O'Neill
authors.affiliation: Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Sreenan
authors.affiliation: Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland.
authors.forename: J H
authors.initials: JH
authors.lastname: McDermott