Silent Myocardial Ischemia: Concern Is Justified for the Patient with Known Coronary Artery Disease

Editorials1 April 1984Silent Myocardial Ischemia: Concern Is Justified for the Patient with Known Coronary Artery DiseaseRICHARD F. LEIGHTON, M.D., THEODORE D. FRAKER JR., M.D.RICHARD F. LEIGHTON, M.D.Search for more papers by this author, THEODORE D. FRAKER JR., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-100-4-599 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe existence of silent myocardial ischemia has been well documented both in patients with known coronary artery disease (1, 2), and in those with previously undetected ischemic heart disease (3, 4). Patients with silent ischemia have been said to have a defective anginal warning system (5), implying that they are unknowingly at risk. We believe the physician's approach to the phenomenon of silent ischemia should differ substantially depending on whether the patient is known to have coronary artery disease.Many patients with coronary disease have myocardial infarction or sudden death as the initial presentation of their illness (6). Some of...References1. MARKIEWICZHOUSTONDEBUSK WNR. Exercise testing soon after myocardial infarction. Circulation. 1977;56:26-31. CrossrefMedlineGoogle Scholar2. THEROUXWATERSHALPHENDEBAISIEUXMIZGALA PDCJH. Prognostic value of exercise testing soon after myocardial infarction. N Engl J Med. 1979;301:341-5. CrossrefMedlineGoogle Scholar3. ERIKSSENENGEFORFANGSTORSTEIN JIKD. False-positive diagnostic tests and coronary angiographic findings in 105 presumably healthy males. Circulation. 1976;54:371-6. CrossrefMedlineGoogle Scholar4. UHLFROELICHER GV. Screening for asymptomatic coronary artery disease. J Am Coll Cardiol. 1983;1:946-55. CrossrefMedlineGoogle Scholar5. COHN P. Silent myocardial ischemia in patients with a defective anginal warning system. Am J Cardiol. 1980;45:697-702. CrossrefMedlineGoogle Scholar6. KANNELDOYLEMCNAMARAQUICKENTONGORDON WJPPT. Precursors of sudden coronary death: factors related to the incidence of sudden death. Circulation. 1975;51:606-13. CrossrefMedlineGoogle Scholar7. SOLOMONEDWARDSKILLIP HAT. Prodromatan in acute myocardial infarction. Circulation. 1969;40:463-71. CrossrefMedlineGoogle Scholar8. KULLERLILIENFELDFISHER LAR. Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease. Circulation. 1968;34:1056-68. CrossrefGoogle Scholar9. BORERBRENSIKEREDWOOD JJD. Limitations of the electrocardiographic response to exercise in predicting coronary artery disease. N Engl J Med. 1975;293:367-71. CrossrefMedlineGoogle Scholar10. EPSTEIN S. Value and limitations of the electrocardiographic response to exercise in the assessment of patients with coronary artery disease. Am J Cardiol. 1978;42:667-74. CrossrefMedlineGoogle Scholar11. WEINERRYANMCCABE DTC. Exercise stress testing: correlations among history of angina, ST-segment response and prevalence of coronary artery disease in the Coronary Artery Surgery Study (CASS). N Engl J Med. 1979;301:230-5. CrossrefMedlineGoogle Scholar12. DIAMONDFORRESTER GJ. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med. 1979;300:1350-8. CrossrefMedlineGoogle Scholar13. MCNEERMARGOLISLEE JJK. The role of the exercise test in the evaluation of patients for ischemic heart disease. Circulation. 1978;57:64-70. CrossrefMedlineGoogle Scholar14. BRUCEDEROUENHOSSACK RTK. Value of maximal exercise tests in risk assessment of primary coronary heart disease in healthy men: five years' experience of the Seattle Heart Watch Study. Am J Cardiol. 1980;46:371-8. CrossrefMedlineGoogle Scholar15. GIAGNONISECCHIWU EMS. Prognostic value of exercise EKG testing in asymptomatic normotensive subjects: a prospective matched study. N Engl J Med. 1983;309:1085-9. CrossrefMedlineGoogle Scholar16. GIBBONSLEEPRYOR RKD. The use of radionuclide angiography in the diagnosis of coronary artery disease-a logistic regression analysis. Circulation. 1983;68:740-6. CrossrefMedlineGoogle Scholar17. AUSTINCOBBCOLEMANJONES EFRR. Prospective evaluation of radionuclide angiocardiography for the diagnosis of coronary artery disease. Am J Cardiol. 1982;50:1212-6. CrossrefMedlineGoogle Scholar18. BERGERABRAMOWITZPARK BRC. Abnormal thallium-201 scans in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol. 1983;52:365-70. CrossrefMedlineGoogle Scholar19. STILESROSATIWALLACE GRA. Clinical relevance of exercise-induced ST segment elevation. Am J Cardiol. 1980;46:931-6. CrossrefMedlineGoogle Scholar20. PATTERSONHOROWITZENG RSC. Can noninvasive exercise test criteria identify patients with left main or 3-vessel coronary disease after a first myocardial infarction? Am J Cardiol. 1983;51:361-72. CrossrefMedlineGoogle Scholar21. WASSERMANKATZCLEARYVARINAREBAROSS ARPVRA. Noninvasive detection of multivessel disease after myocardial infarction by exercise radionuclide ventriculography. Am J Cardiol. 1982;50:1242-7. CrossrefMedlineGoogle Scholar22. . Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery: survival data. Circulation. 1983;68:939-50. CrossrefMedlineGoogle Scholar23. Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet. 1982;2:1173-9. MedlineGoogle Scholar24. HAMMERMEISTER K. The effects of coronary bypass surgery on survival. Prog Cardiovasc Dis. 1983;25:297-334. CrossrefMedlineGoogle Scholar25. ALDERMANFISHERLITWIN ELP. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983;68:785-95. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Medical College of Ohio Toledo, Ohio PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPre-synaptic sympathetic calcium channels, cyclic nucleotide-coupled phosphodiesterases and cardiac excitabilityCoronary angioplasty in silent myocardial ischemiaFrequent episodes of silent myocardial ischemia after apparently uncomplicated myocardial infarction 1 April 1984Volume 100, Issue 4Page: 599-601KeywordsCardiovascular therapyIschemiaMyocardial infarctionStable coronary artery disease Issue Published: 1 April 1984 PDF downloadLoading ...