Does the Brain Know When the Heart Is Ischemic?

Editorials1 June 1996Does the Brain Know When the Heart Is Ischemic?Carl J. Pepine, MDCarl J. Pepine, MDUniversity of Florida Gainesville, FL 32610-0277Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-11-199606010-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Chest pain has traditionally been accepted as the principal warning of ischemic heart disease, but doubts were raised long ago about whether severe ischemia is always signaled by chest pain [1]. With better ambulatory and in-hospital monitoring, it has become apparent over the years that patients who have angina, have had infarction, or are elderly have most of their ischemic episodes without chest pain [2-6]. It follows that the objective signals of cardiac ischemia (such as transient electrocardiographic ST-segment depression, perfusion, or wall motion abnormalities) are more closely linked with adverse outcomes than either the presence or severity of chest ...References1. Gorham LW, Martin SJ. Coronary occlusion with and without pain. Arch Intern Med. 1938; 62:821-39. Google Scholar2. Schang SJ Jr, Pepine CJ. Transient asymptomatic S-T segment depression during daily activity. Am J Cardiol. 1977; 39:396-402. Google Scholar3. Aronow WS, Epstein S. Usefulness of silent myocardial ischemia detected by ambulatory electrocardiographic monitoring in predicting new coronary events in elderly patients. Am J Cardiol. 1988; 62:1295-6. Google Scholar4. Gottlieb SO, Gottlieb SH, Achuff SC, Baumgardner R, Mellits ED, Weisfeldt ML, et al. Silent ischemia on Holter monitoring predicts mortality in high-risk postinfarction patients. JAMA. 1988; 259:1030-5. Google Scholar5. 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Effects of titrated β blockade (metoprolol) on silent myocardial ischemia in ambulatory patients with coronary artery disease. Am J Cardiol. 1987; 60:519-24. Google Scholar Author, Article, and Disclosure InformationAuthors: Carl J. Pepine, MDAffiliations: University of Florida Gainesville, FL 32610-0277Corresponding Author: Carl J. Pepine, MD, Division of Cardiovascular Medicine, University of Florida, Box 100277, Gainesville, FL 32610-0277. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSilent Ischemia as a Central Problem: Regional Brain Activation Compared in Silent and Painful Myocardial Ischemia Stuart D. Rosen , Eraldo Paulesu , Petros Nihoyannopoulos , Dimitris Tousoulis , Richard S.J. Frackowiak , Christopher D. Frith , Terry Jones , and Paolo G. Camici Unexplained Chest Pain: The Hypersensitive, Hyperreactive, and Poorly Compliant Esophagus Satish S.C. Rao , Hans Gregersen , Bernard Hayek , Robert W. Summers , and James Christensen Diagnostic Value of Esophageal Studies in Patients with Angina-like Chest Pain and Normal Coronary Angiograms Ole Frobert , Peter Funch-Jensen , and Jens Peder Bagger Match and Mismatch: Identifying the Neuronal Determinants of Pain Kenneth L. Casey Metrics Cited byGender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV MedicineGender in cardiovascular medicine: chest pain and coronary artery diseaseNociceptive and Neuropathic Pain Qualities in Men and Women with Acute Coronary Syndromes: A Complex Pain PresentationRandomized Controlled Trial of a Psychoeducation Program for the Self-Management of Chronic Cardiac PainThe Editor’s Roundtable: Chronic Stable Angina PectorisDolores tor?cicosCerebral cortical hyperactivation in response to mental stress in patients with coronary artery diseaseExtent of ischemic stimulus and plasma β-endorphin levels in silent myocardial ischemiaIschemic Burden in Silent and Painful Myocardial Ischemia: A Quantitative Exercise Sestamibi Tomographic Study 1 June 1996Volume 124, Issue 11Page: 1006-1008KeywordsArrhythmiaBlood pressureBrainCardiovascular therapyElectrocardiographyHeartIschemiaPerceptionPsychologyThalamus ePublished: 15 August 2000 Issue Published: 1 June 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. 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