Symptoms and Signs of Myocardial Ischemia

Abstract

A transient regional inbalance between oxygen demand and supply usually results in myocardial ischemia whose signs and symptoms can be used as a diagnostic tool. Myocardial ischemia results in a typical “cascade” of events in which the various markers are hierarchically ranked in a well-defined time sequence [2]. The flow heterogeneity, especially between subendocardial and subepicardial perfusion, is the forerunner of ischemia, followed by the metabolic changes, by the alterations in the ventricular diastolic relaxation, by the regional dyssynergy, and only at a later stage by electrocardiographic changes, global left ventricular dysfunction, and pain (Fig. 1).

Our surprise in finding out that a new approach gives information that the old methods do not give, in detecting myocardial ischemia, does not differ from the surprise that an intelligent primitive human would experience if he were suddenly confronted with the problem of understanding what makes a car run. After a short observation he would probably first conclude that if you smash your car probably it will not run any more. Then he will discover that even an intact car will not run if its engine is broken. With time he will come to the astonishing discovery that even intact cars with intact engines, may not run if they run out of gasoline, and, furthermore, that some will not run even when full of gasoline. This, they would probably classify as a super-silent trouble

L. Donato [1]