Silent Myocardial Ischemia

Although much progress has been made in reducing mortality from ischemic cardiovascular disease, this condition remains the leading cause of death throughout the world. This might in part be due to the fact that over half of patients have a catastrophic event (heart attack or sudden death) as their...

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Bibliographic Details
Published in:Circulation Journal 2009, Vol.73(5), pp.785-797
Main Author: Gutterman, David D.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Angina
Angina Pectoris - etiology
Death, Sudden, Cardiac - etiology
Early Diagnosis
Female
Humans
Ischemia
Ischemic heart disease
Male
Middle Aged
Myocardial infarction
Myocardial Infarction - etiology
Myocardial Ischemia - complications
Myocardial Ischemia - diagnosis
Myocardial Ischemia - mortality
Myocardial Ischemia - physiopathology
Predictive Value of Tests
Prevalence
Risk Assessment
Treatment Outcome
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Summary:Although much progress has been made in reducing mortality from ischemic cardiovascular disease, this condition remains the leading cause of death throughout the world. This might in part be due to the fact that over half of patients have a catastrophic event (heart attack or sudden death) as their initial manifestation of coronary disease. Contributing to this statistic is the observation that the majority of myocardial ischemic episodes are silent, indicating an inability or failure to sense ischemic damage or stress on the heart. This review examines the clinical characteristics of silent myocardial ischemia, and explores mechanisms involved in the generation of angina pectoris. Possible mechanisms for the more common manifestation of injurious reductions in coronary flow; namely, silent ischemia, are also explored. A new theory for the mechanism of silent ischemia is proposed. Finally, the prognostic importance of silent ischemia and potential future directions for research are discussed. (Circ J 2009; 73: 785 - 797)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-08-1209