Silent myocardial ischemia: Prognosis and therapy
- Prakash C Deedwania, MD
Prakash C Deedwania, MD
- Professor of Medicine
- University of California San Francisco School of Medicine
- Section Editor
- Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
- Section Editor — Coronary Heart Disease
- Professor of Cardiovascular Science
- Director, Cardiovascular and Cell Sciences Research Institute
- St. George's, University of London
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 . (See "Angina pectoris: Chest pain caused by myocardial ischemia".)
Issues related to treatment and prognosis of silent myocardial ischemia will be reviewed here. The epidemiology, pathophysiology, and diagnosis of silent myocardial ischemia are discussed separately. (See "Silent myocardial ischemia: Epidemiology, pathophysiology, and diagnosis".)
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. Objective evidence of silent myocardial ischemia may be obtained through ambulatory electrocardiographic (ECG) monitoring or cardiac stress testing. (See "Silent myocardial ischemia: Epidemiology, pathophysiology, and diagnosis", section on 'Definition'.)
The prognosis of patients with silent myocardial ischemia may be viewed from the standpoint of two groups of patients: those without a history of coronary heart disease (CHD) or angina pectoris, and those with a history of CHD . Additionally, there appears to be a "dose dependence," with patients who have more frequent or more sustained episodes of silent ischemia at greater risk for adverse events [3,4].
The precise reason for the adverse prognosis associated with silent ischemia is not known. Hypotheses center around abnormalities such as necrosis or progressive fibrosis leading to left ventricular dysfunction and/or ventricular arrhythmias [5-7].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Patients with known CHD
- Patients without known CHD (asymptomatic patients)
- Secondary prevention of cardiovascular disease
- Medical therapy directed at silent myocardial ischemia
- - Beta blockers
- - Calcium channel blockers
- - Combination therapy
- - Stress reduction
- - Statin therapy
- - Silent myocardial ischemia following MI
- - Silent myocardial ischemia not following MI
- - Silent myocardial ischemia following previous revascularization
- SUMMARY AND RECOMMENDATIONS