When Is Concern About Silent Myocardial Ischemia Justified?

Excerpt

Primary physicians need to know more about the prognostic and therapeutic implications of silent (asymptomatic, painless) myocardial ischemia. There is growing concern that certain asymptomatic patients with coronary artery disease, who repeatedly have silent ischemia, may be at increased risk for a serious cardiac event. This concern is based on the large number of patients with coronary artery disease whose first clinical manifestation of that disease is sudden death or a myocardial infarction.

What is silent myocardial ischemia? Usually, we equate angina with myocardial ischemia, but the former is merely the subjective manifestation of the latter, and chest pain or