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Silent myocardial ischemia: Epidemiology, pathophysiology, and diagnosis

Prakash C Deedwania, MD
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Brian C Downey, MD, FACC


Angina pectoris, the term used for symptoms thought to be attributable to myocardial ischemia, typically manifests as chest discomfort, although other associated symptoms with ischemia may be present (eg, exertional shortness of breath, nausea, diaphoresis, fatigue). While angina has long been considered the cardinal symptom of myocardial ischemia and coronary heart disease, "silent" (asymptomatic) myocardial ischemia is the most common manifestation of coronary heart disease (CHD), accounting for more than 75 percent of ischemic episodes during daily life as assessed by electrocardiographic (ECG) monitoring [1]. (See "Angina pectoris: Chest pain caused by myocardial ischemia".)

The epidemiology, pathophysiology, and diagnosis of silent myocardial ischemia will be reviewed here. Issues related to treatment and prognosis of silent myocardial ischemia are discussed separately. (See "Silent myocardial ischemia: Prognosis and therapy".)


Silent myocardial ischemia is defined as the presence of objective evidence of myocardial ischemia in the absence of chest discomfort or another anginal equivalent symptom (eg, dyspnea, nausea, diaphoresis, etc). Objective evidence of silent myocardial ischemia may be obtained in several ways:

ST segment changes consistent with ischemia seen during exercise treadmill testing or ambulatory monitoring. (See "Exercise ECG testing: Performing the test and interpreting the ECG results", section on 'ST segment depression'.)

Reversible myocardial perfusion defects noted during radionuclide myocardial perfusion imaging. (See "Stress testing for the diagnosis of obstructive coronary heart disease", section on 'Radionuclide myocardial perfusion imaging'.)

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Literature review current through: Nov 2017. | This topic last updated: Jul 06, 2016.
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