Silent Myocardial Ischemia

  • Brian P. Schafer
  • Thomas C. Andrews
  • Peter H. Stone
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 217)

Abstract

Until recently, our understanding of coronary artery disease has been dominated by the misconception that myocardial ischemia is an inherently painful phenomenon. In 1772, William Heberden described angina pectoris as a “strangling … most disagreeable sensation in the breast,”1 and later in the 18th century C.H. Parry associated angina with narrowing of the coronary arteries.2 It was not until 1950 that silent ischemia was first described when Paul Wood reported 25% of patients with exertional angina who developed asymptomatic repolarization abnormalities of ischemia during exercise electrocardiography.3 Subsequently, data from the Framingham study has demonstrated that 25 % of myocardial infarctions are clinically silent.4 Stem and Tzivoni in 1974 were the first to demonstrate silent ischemia using ambulatory monitoring in coronary patients during normal daily activities.5 Over the past decade silent ischemia has emerged as an important manifestation of ischemic heart disease, and in this chapter we review the current understanding of the pathophysiology, detection, prognostic significance and treatment of this disorder.

Keywords

Placebo Depression Ischemia Cortisol Serotonin 

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© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Brian P. Schafer
  • Thomas C. Andrews
  • Peter H. Stone

There are no affiliations available

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