Skip to main content
SpringerLink
Log in

Daily Life Cardiac Ischaemia

Should It Be Treated?

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Summary

Daily life cardiac ischaemia is defined as reversible myocardial cellular hypoxia that occurs during activities of daily living, without artificial provocation. Most of these daily life ischaemic episodes are not associated with symptoms. However, it is not practical to distinguish silent versus symptomatic daily life ischaemia as both are associated with haemodynamic abnormalities and future adverse outcomes. Daily life cardiac ischaemia is best detected using ambulatory electrocardiogram (ECG) monitoring; however, there are other diagnostic tools (e.g. exercise treadmill) that can be used. Once detected, the optimal therapy for daily life myocardial ischaemia has yet to be identified. However, it does appear that usual antianginal medications including nitrates, β-blockers, calcium antagonists and antiplatelet drugs are effective in reducing the incidence and severity of daily life myocardial ischaemia. Medical therapy and revascularisation should be utilised to obliterate all episodes of daily life cardiac ischaemia to prevent future cardiac events. Moreover, the efficacy of the chosen therapeutic regimen for each patient should be documented with follow-up objective testing. The diagnosis and management of daily life myocardial ischaemia is continually evolving. Future research as well as economic considerations will shape future management strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schang SJ, Pepine CJ. Transient asymptomatic S-T segment depression during daily activity. Am J Cardiol 1977; 39: 396–402.

    PubMed  Google Scholar 

  2. Deanfield JE, Maseri A, Selwyn AP, et al. Myocardial ischaemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes. Lancet 1983; 1: 753–8.

    Google Scholar 

  3. Deedwania PC, Nelson JR. Pathophysiology of silent myocardial ischemia during daily life. Circulation 1990; 82: 1296–304.

    PubMed  CAS  Google Scholar 

  4. Barry J, Selwyn AP, Nabel EG, et al. Frequency of ST-segment depression produced by mental stress in stable angina pectoris from coronary artery disease. Am J Cardiol 1988; 61: 989–93.

    PubMed  CAS  Google Scholar 

  5. Hirzel HO, Leutwyler R, Krayenbuehl HP. Silent myocardial ischemia: hemodynamic changes during dynamic exercise in patients with proven coronary artery disease despite absence of angina pectoris. J Am Coll Cardiol 1985; 6: 275–84.

    PubMed  CAS  Google Scholar 

  6. Weiner DA, Ryan TJ, McCabe CH, et al. Significance of silent myocardial ischemia during exercise testing in patients with coronary artery disease. Am J Cardiol 1987; 59: 725–9.

    PubMed  CAS  Google Scholar 

  7. Warnes CA, Roberts WC. Morphologic findings in sudden coronary death: a comparison of those with and without previous symptoms of myocardial ischemia. Cardiol Clin 1986; 4: 607–15.

    PubMed  CAS  Google Scholar 

  8. Gunther H, Osterspey A, Tres-Muller I, et al. The sensitivity of 24h Holter monitoring and exercise testing for the recognition of myocardial ischemia: a comparative study. Eur Heart J 1988; 9: 46–9.

    PubMed  Google Scholar 

  9. Coy KM, Imperi GA, Lambert CR, et al. Silent myocardial ischemia during daily activities in asymptomatic men with positive exercise test response. Am J Cardiol 1987; 59: 45–9.

    PubMed  CAS  Google Scholar 

  10. Raby KE, Barry J, Treasure CB, et al. Usefulness of Holter monitoring for detecting myocardial ischemia in patients with nondiagnostic exercise treadmill test. Am J Cardiol 1993; 72: 889–93.

    PubMed  CAS  Google Scholar 

  11. Bertolet BD, Boyette AF, Hofmann CA, et al. Prevalence of pseudo-ischemic ST-segment changes during ambulatory ECG monitoring. Am J Cardiol 1992; 70: 818–20.

    PubMed  CAS  Google Scholar 

  12. Nabel EG, Barry J, Rocco MB, et al. Variability of transient myocardial ischemia in ambulatory patients with coronary artery disease. Circulation 1988; 78: 60–7.

    PubMed  CAS  Google Scholar 

  13. Bertolet BD, Hofmann CA, Kolb KB, et al. Evaluation of a novel miniature digital ambulatory ECG transient myocardial ischemia detection system. J Ambulatory Monitoring 1992; 5: 33–9.

    Google Scholar 

  14. Sharaf BL, Williams DO, McMahon RP, et al. Is there a high prevalence of complex plaque in patients with asymptomatic cardiac ischemia? Qualitative and quanitative description of coronary anatomy in patients in the ACIP study. J Am Coll Cardiol 1993; 21: 46A.

    Google Scholar 

  15. Deedwania PC, Carabajal EV. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation 1990; 81: 748–56.

    PubMed  CAS  Google Scholar 

  16. Rocco MB, Nabel EG, Campbell S, et al. Prognostic importance of myocardial ischemia detected by ambulatory monitoring in patients with stable coronary artery disease. Circulation 1988; 78: 877–84.

    PubMed  CAS  Google Scholar 

  17. Yeung AC, Barry J, Orav J, et al. Effects of asymptomatic ischemia on long-term prognosis in chronic stable coronary disease. Circulation 1991; 83: 1598–604.

    PubMed  CAS  Google Scholar 

  18. Stern S, Tzivoni D. Early detection of silent ischaemic heart disease by 24-hour electrocardiographic monitoring of active subjects. Br Heart J 1974; 36: 481–6.

    PubMed  CAS  Google Scholar 

  19. Nademanee K, Intarachot V, Josephson MA, et al. Prognostic significance of silent myocardial ischemia in patients with unstable angina. J Am Coll Cardiol 1987; 10: 1–9.

    PubMed  CAS  Google Scholar 

  20. Wilcox I, Freedman SB, Kelly DT, et al. Clinical significance of silent ischemia in unstable angina pectoris. Am J Cardiol 1990; 65: 1313–16.

    PubMed  CAS  Google Scholar 

  21. Pozzati A, Bugiardini R, Borghi A, et al. Prognostic significance of myocardial ischemia refractory to maximal medical therapy in unstable angina [abstract]. Circulation 1988; 78 Suppl. 11: 11–421.

    Google Scholar 

  22. Gottlieb SO, Gottlieb SH, Achuff SC, et al. Silent ischemia on Holter monitoring predicts mortality in high-risk postinfarction patients. JAMA 1988; 259: 1030–5.

    PubMed  CAS  Google Scholar 

  23. Tzivoni D, Gavish A, Zin D, et al. Prognostic significance of ischemie episodes in patients with previous myocardial infarction. Am J Cardiol 1988; 62: 661–4.

    PubMed  CAS  Google Scholar 

  24. Jereczek M, Andresen D, Schroder J, et al. Prognostic value of ischemia during Holter monitoring and exercise testing after acute myocardial infarction. Am J Cardiol 1993; 72: 8–13.

    PubMed  CAS  Google Scholar 

  25. Langer A, Minkowitz J, Dorian P, et al. Pathophysiology and prognostic significance of Holter-detected ST segment depression after myocardial infarction. J Am Coll Cardiol 1992; 20: 1313–7.

    PubMed  CAS  Google Scholar 

  26. Petretta M, Bonaduce D, Bianchi V, et al. Characterization and prognostic significance of silent myocardial ischemia on predischarge electrocardiographic monitoring in unselected patients with myocardial infarction. Am J Cardiol 1992; 69: 579–83.

    PubMed  CAS  Google Scholar 

  27. Moss AJ, Goldstein RE, Hall J, et al. Detection and significance of myocardial ischemia in stable patients after recovery from an acute coronary event. JAMA 1993; 269: 2379–85.

    PubMed  CAS  Google Scholar 

  28. Multiple Risk Factor Intervention Trial Research Group. Exercise electrocardiogram and coronary heart disease mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol 1985; 55: 16–24.

    Google Scholar 

  29. Multiple Risk Factor Intervention Trial Research Group. Mortality rates after 10.5 years for participants in the Multiple Risk Factor Intervention Trial. JAMA 1990; 263: 1795–801.

    Google Scholar 

  30. Gordon DJ, Lars-Goran E, Karon JM, et al. Predictive value of the exercise tolerance test in North American men: the Lipid Research Clinics Mortality Follow-up Study. Circulation 1986; 74: 252–61.

    PubMed  CAS  Google Scholar 

  31. Cashin-Hemphill L, Mack WJ, Pogoda JM, et al. Beneficial effects of colestipol-niacin on coronary atherosclerosis: a 4-year follow-up. JAMA 1990; 264: 3013–7.

    PubMed  CAS  Google Scholar 

  32. Kane JP, Malloy MJ, Ports TA, et al. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA 1990; 264: 3007–12.

    PubMed  CAS  Google Scholar 

  33. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990; 323: 1289–98.

    PubMed  CAS  Google Scholar 

  34. Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease: the Stanford coronary risk intervention project (SCRIP). Circulation 1994; 89: 975–90.

    PubMed  CAS  Google Scholar 

  35. Pepine CJ, Feldman RL, Ludbrook P, et al. Left ventricular dyskinesia reversed by intravenous nitroglycerin: a manifestation of silent myocardial ischemia. Am J Cardiol 1986; 58: 38B–42B.

    PubMed  CAS  Google Scholar 

  36. Shell WE. Mechanisms and therapy of silent myocardial ischemia and the effect of transdermal nitroglycerin. Am J Cardiol 1985; 56: 231–71.

    Google Scholar 

  37. Schneeweiss A, Marmor A. Transdermal nitroglycerin patches for silent myocardial ischemia during antianginal treatment. Am J Cardiol 1988; 61: 36E–38E.

    PubMed  CAS  Google Scholar 

  38. Levin RI. Quantitation of transient myocardial ischemia by digital, ambulatory electrocardiography. Am J Cardiol 1988; 61: 13B–17B.

    PubMed  CAS  Google Scholar 

  39. Dubiel JP, Moczurad KW, Bryniarski L. Efficacy of a single dose of slow-release isosorbide dinitrate in the treatment of silent or painful myocardial ischemia in stable angina patients. Am J Cardiol 1992; 69: 1156–60.

    PubMed  CAS  Google Scholar 

  40. Von Arnim T, Erath A. Nitrates and calcium antagonists for silent myocardial ischemia. Am J Cardiol 1988; 61: 15E–18E.

    Google Scholar 

  41. Feng J, Feng X, Schneeweiss A. Efficacy of isosorbide 5-mononitrate on painful and silent myocardial ischemia after myocardial infarction. Am J Cardiol 1990; 65: 32J–35J.

    PubMed  CAS  Google Scholar 

  42. Distante A, Maseri A, Severi S, et al. Management of vasospastic angina at rest with continuous infusion of isosorbide dinitrate: a double crossover study in a coronary care unit. Am J Cardiol 1979; 44: 533–8.

    PubMed  CAS  Google Scholar 

  43. Quyyumi AA, Crake T, Wright CM, et al. Medical treatment of patients with severe exertional and rest angina: double blind comparison of β-blocker, calcium antagonist, and nitrate. Br Heart J 1987; 57: 505–11.

    PubMed  CAS  Google Scholar 

  44. Lam JYT, Chesebro JH, Fuster V. Platelets, vasoconstriction and nitroglycerin during arterial wall injury: a new antithrombotic role for an old drug. Circulation 1988; 78: 712–6.

    PubMed  CAS  Google Scholar 

  45. Folts JD, Stamler J, Loscalzo J. Intravenous nitroglycerin infusion inhibits cyclic blood flow responses caused by periodic platelet thrombus formation in stenosed canine coronary arteries. Circulation 1991; 83: 2122–7.

    PubMed  CAS  Google Scholar 

  46. Chirkov YY, Naujalis JI, Barber S, et al. Reversal of human platelet aggregation by low concentrations of nitroglycerin in vitro in normal subjects. Am J Cardiol 1992; 70: 802–6.

    PubMed  CAS  Google Scholar 

  47. Nabel EG, Barry J, Rocco MB, et al. Effects of dosing intervals on the development of tolerance to high dose transdermal nitroglycerin. Am J Cardiol 1989; 63: 663–9.

    PubMed  CAS  Google Scholar 

  48. Fox KM, Dargie H, Deanfield J, et al. Avoidance of tolerance and lack of rebound with intermittent dose titrated transdermal glyceryl trinitrate. Br Heart J 1991; 66: 151–5.

    PubMed  CAS  Google Scholar 

  49. Lambert CR, Coy K, Imperi G, et al. Influence of beta-adrenergic blockade defined by time series analysis on circadian variation of heart rate and ambulatory myocardial ischemia. Am J Cardiol 1989; 64: 835–9.

    PubMed  CAS  Google Scholar 

  50. Willich SN, Pohjola-Sintonen S, Bhatia SJS, et al. Suppression of silent ischemia by metoprolol without alteration of morning increase of platelet aggregability in patients with stable coronary artery disease. Circulation 1989; 79: 557–65.

    PubMed  CAS  Google Scholar 

  51. Cohn PF, Lawson WE. Effects of long-acting propranolol on A.M. and P.M. peaks in silent myocardial ischemia. Am J Cardiol 1989; 63: 872–3.

    PubMed  CAS  Google Scholar 

  52. Stone PH, Gibson RS, Glasser SP, et al. Comparison of propranolol, diltiazem, and nifedipine in the treatment of ambulatory ischemia in patients with stable angina. Circulation 1990; 82: 1962–72.

    PubMed  CAS  Google Scholar 

  53. Khurmi NS, Bowles MJ, o’Hara MJ, et al. Effect of propranolol on indices of intermittent myocardial ischemia, assessed by exercise testing and ambulatory ST-segment monitoring. Clin Cardiol 1986; 6: 391–7.

    Google Scholar 

  54. Parodi O, Simonetti I, L’Abbate A, et al. Verapamil versus propranolol for angina at rest. Am J Cardiol 1982; 50: 923–8.

    PubMed  CAS  Google Scholar 

  55. Imperi GA, Lambert CR, Coy K, et al. Effects of titrated beta blockade (metoprolol) on silent myocardial ischemia in ambulatory patients with coronary artery disease. Am J Cardiol 1987; 60: 519–24.

    PubMed  CAS  Google Scholar 

  56. Hill JA, Gonzalez JI, Kolb R, et al. Effects of atenolol alone, nifedipine alone and their combination on ambulant myocardial ischemia. Am J Cardiol 1990; 66: 1157–62.

    Google Scholar 

  57. Mulcahy D, Keegan J, Cunningham D, et al. Circadian variation of total ischemic burden and its alteration with anti-anginal agents. Lancet 1988; 2: 755–9.

    PubMed  CAS  Google Scholar 

  58. Quyyumi AA, Wright C, Mockus L, et al. Effect of partial agonist activity in beta-blockers in severe angina pectoris: a double blind comparison of pindolol and atenolol. BMJ 1984; 289: 951–3.

    PubMed  CAS  Google Scholar 

  59. Quyyumi AA, Crake T, Wright CM, et al. Medical treatment of patients with severe exertional and rest angina: double blind comparison of β blocker, calcium antagonist, and nitrate. Br Heart J 1987; 57: 505–11.

    PubMed  CAS  Google Scholar 

  60. Egstrup K. Transient myocardial ischemia after abrupt withdrawal of antianginal therapy in chronic stable angina. Am J Cardiol 1988; 61: 1219–22.

    PubMed  CAS  Google Scholar 

  61. Cohn PF, Lawson WE. Effect of nifedipine on out-of-hospital silent myocardial ischemia in asymptomatic men with coronary artery disease. Am J Cardiol 1988; 61: 908–10.

    PubMed  CAS  Google Scholar 

  62. Pust B, Sebenik M, Obrez I. Prevention of pacing-induced silent myocardial ischaemia by nifedipine in coronary heart disease. Eur Heart J 1988; 9 Suppl. N: 151–7.

    PubMed  Google Scholar 

  63. Nesto RW, Phillips RT, Kett KG, et al. Effect of nifedipine on total ischemic activity and circadian distribution of myocardial ischemic episodes in angina pectoris. Am J Cardiol 1991; 67: 128–32.

    PubMed  CAS  Google Scholar 

  64. Parmley WW, Nesto RW, Singh BN, et al. Attenuation of the circadial patterns of myocardial ischemia with nifedipine GITS in patients with chronic stable angina. J Am Coll Cardiol 1992; 19: 1380–9.

    PubMed  CAS  Google Scholar 

  65. Previtali M, Salerno JA, Tavazzi L, et al. Treatment of angina at rest with nifedipine: a short-term controlled study. Am J Cardiol 1980; 45: 825–30.

    PubMed  CAS  Google Scholar 

  66. Gelman JS, Feldman RL, Scott E, et al. Nicardipine for angina pectoris at rest and coronary arterial spasm. Am J Cardiol 1985; 56: 232–6.

    PubMed  CAS  Google Scholar 

  67. Deedwania PC, Cheitlin MD, Das SK, et al. Amlodipine once a day in stable angina: double-blind crossover comparison with placebo. Clin Card 1993; 16: 599–602.

    CAS  Google Scholar 

  68. Mulcahy D, Purcell H, Sparrow J, et al. Effects of amlodipine versus diltiazem on morning peak in myocardial ischemic activity in angina pectoris. Am J Cardiol 1993; 72: 1203–6.

    PubMed  CAS  Google Scholar 

  69. Frishman W, Charlap S, Kimmel B, et al. Diltiazem, nifedipine and their combination in patients with stable angina pectoris: effects on angina, exercise tolerance, and the ambulatory electrocardiographic ST segment. Circulation 1988; 77: 774–86.

    PubMed  CAS  Google Scholar 

  70. Theroux P, Baird M, Juneau M, et al. Effect of diltiazem upon episodes of silent myocardial ischemia during daily life [abstract]. J Am Coll Cardiol 1990; 15: 120A.

    Google Scholar 

  71. Juneau M, Theroux P, Waters D, et al. Effect of diltiazem slow-release formulation on silent myocardial ischemia in stable coronary artery disease. Am J Cardiol 1992; 69: 30B–5B.

    PubMed  CAS  Google Scholar 

  72. Fang ZY, Picart N, Abramowicz M, et al. Intravenous diltiazem versus nitroglycerin for silent and symptomatic myocardial ischemia in unstable angina pectoris. Am J Cardiol 1991; 68: 42C–6C.

    PubMed  CAS  Google Scholar 

  73. Johnson SM, Mauritson DR, Corbett JR, et al. Double-blind, randomized, placebo-controlled comparison of propranolol and verapamil in the treatment of patients with stable angina pectoris. Am J Med 1981; 71: 443–51.

    PubMed  CAS  Google Scholar 

  74. Parodi O, Simonetti I, Michelassi C, et al. Comparison of verapamil and propranolol therapy for angina pectoris at rest: a randomized, multiple-crossover, controlled trial in the coronary care unit. Am J Cardiol 1986; 57: 899–906.

    PubMed  CAS  Google Scholar 

  75. L-Lacoste L, Lam JYT, Hung J, et al. Oral verapamil inhibits platelet thrombus formation in humans. Circulation 1994; 89: 630–4.

    PubMed  CAS  Google Scholar 

  76. Pepine CJ. β-blockers or calcium antagonists in silent ischaemia? Eur Heart J 1993; 14: 7–14.

    PubMed  Google Scholar 

  77. Mahony C. Effect of aspirin on myocardial ischemia. Am J Cardiol 1989; 64: 387–9.

    PubMed  CAS  Google Scholar 

  78. Fox KM, Jonathan A, Selwyn AP. Effects of platelet inhibition on myocardial ischaemia. Lancet 1982; 2: 727–30.

    PubMed  CAS  Google Scholar 

  79. Vejar M, Hackett D, Brunelli C, et al. Comparison of low-dose aspirin and coronary vasodilators in acute unstable angina. Circulation 1990; 81 Suppl. I: I–4–I–11.

    Google Scholar 

  80. Serneri GGN, Gensini GF, Poggesi L, et al. Effect of heparin, aspirin, or alterplase in reduction of myocardial ischemia in refractory unstable angina. Lancet 1990; 335: 615–8.

    Google Scholar 

  81. Nyman I, Larsson H, Wallentin L, et al. Prevention of serious cardiac events by low-dose aspirin in patients with silent myocardial ischemia. Lancet 1992; 340: 497–501.

    PubMed  CAS  Google Scholar 

  82. Oakley GDG, Fox KM, Dargie HJ, et al. Objective assessment of treatment in severe angina. BMJ 1979; 1: 1540.

    PubMed  CAS  Google Scholar 

  83. Dargie HJ, Lynch PG, Krikler DM, et al. Nifedipine and propranolol: a beneficial drug interaction. Am J Med 1981; 71: 676–82.

    PubMed  CAS  Google Scholar 

  84. Subramanian B, Bowles MJ, Davies AB, et al. Combined therapy with verapamil and propranolol in chronic stable angina. Am J Cardiol 1982; 49: 125–32.

    PubMed  CAS  Google Scholar 

  85. Parisi AF, Folland ED, Hartigan P, et al. A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med 1992; 326: 10–6.

    PubMed  CAS  Google Scholar 

  86. Finci L, Chatelain P, Meier B, et al. Silent myocardial ischemia: a critical appraisal. Adv Cardiol 1990; 37: 278–87.

    PubMed  CAS  Google Scholar 

  87. Josephson MA, Nademanee K, Intarachot V, et al. Abolition of Holter monitor detected silent myocardial ischemia after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1987; 10: 499–503.

    PubMed  CAS  Google Scholar 

  88. Mulcahy D, Keegan J, Phadke K, et al. Effects of coronary artery bypass surgery and angioplasty on the total ischemic burden: a study of exercise testing and ambulatory ST segment monitoring. Am Heart J 1992; 123: 597–603.

    PubMed  CAS  Google Scholar 

  89. Anderson HV, Talley JD, Black AJR, et al. Usefulness of coronary angioplasty in asymptomatic patients. Am J Cardiol 1990; 65: 35–9.

    PubMed  CAS  Google Scholar 

  90. Bergin P, Myler RK, Shaw RE, et al. Transluminal coronary angioplasty in the treatment of silent ischemia. Cathet Cardiovasc Diagn 1988; 15: 223–8.

    PubMed  CAS  Google Scholar 

  91. Stone GW, Spaude S, Ligon RW, et al. Usefulness of percutaneous transluminal coronary angioplasty in alleviating silent myocardial ischemia in patients with absent or minimal painful myocardial ischemia. Am J Cardiol 1989; 64: 560–4.

    PubMed  CAS  Google Scholar 

  92. Tuzcu EM, Nisanci Y, Simpfendorfer C, et al. Percutaneous transluminal coronary angioplasty in silent ischemia. Am Heart J 1990; 119: 797–801.

    PubMed  CAS  Google Scholar 

  93. Droste C, Lemmen S, Nitsche R, et al. ST segment monitoring before, three weeks and six months after aortocoronary bypass surgery. Eur Heart J 1988; 9 Suppl. N: 169–75.

    PubMed  Google Scholar 

  94. Lim R, Dyke L, Dymond DS. Effect on prognosis of abolition of exercise-induced painless myocardial ischemia by medical therapy. Am J Cardiol 1992; 69: 733–5.

    PubMed  CAS  Google Scholar 

  95. Raby KE, Barry J, Vita G, et al. Prognostic significance of asymptomatic ischemia’s response to medical therapy [abstract]. Circulation 1993; 88: 1–298.

    Google Scholar 

  96. Nikutta P, Kurzrock N, Delloch V, et al. The unfavorable prognosis of silent ischemia can be improved by appropriate therapy [abstract]. J Am Coll Cardiol 1993; 21: 46A.

    Google Scholar 

  97. Weiner DA, Ryan TJ, McCabe CH, et al. Comparison of coronary artery bypass surgery and medical therapy in patients with exercised-induced silent myocardial ischemia: a report from the Coronary Artery Surgery Study (CASS) Registry. J Am Coll Cardiol 1988; 12: 595–9.

    PubMed  CAS  Google Scholar 

  98. Deligonul U, Vandormael MG, Younis LT, et al. Prognostic significance of silent myocardial ischemia detected by early treadmill exercise after coronary angioplasty. Am J Cardiol 1989; 64: 1–5.

    PubMed  CAS  Google Scholar 

  99. Pepine CJ, Cohn PF, Deedwania PC, et al. Effects of treatment on outcome in mildly symptomatic patients with ischemia during daily life: the Atenolol Silent Ischemia Study (ASIST). Circulation 1994; 90: 762–8.

    PubMed  CAS  Google Scholar 

  100. Knatterud GL, Bourassa MG, Pepine CJ, et al. Effects of treatment strategies to suppress ischemia in patients with coronary artery disease: 12-week results of the Asymptomatic Cardiac Ischemia Pilot (ACIP) study. J Am Coll Cardiol 1994; 24: 11–20.

    PubMed  CAS  Google Scholar 

  101. Rogers W, Bourassa M, Andrews T, et al. Asymptomatic Cardiac Ischemia Pilot Study: 1 year follow-up [abstract]. Circulation 1994; 90: 1–17.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, J.H.M.H.C., University of Florida Health Sciences Center and Veterans Affairs Medical Center, Box 100-277, Gainesville, Florida, 32610, USA

    Barry D. Bertolet & Carl J. Pepine

Authors
  1. Barry D. Bertolet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carl J. Pepine
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bertolet, B.D., Pepine, C.J. Daily Life Cardiac Ischaemia. Drugs 49, 176–195 (1995). https://doi.org/10.2165/00003495-199549020-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199549020-00003

Keywords

Search

Navigation