Silent Myocardial Ischemia: Concern Is Justified for the Patient with Known Coronary Artery Disease

Excerpt

The existence of silent myocardial ischemia has been well documented both in patients with known coronary artery disease (1, 2), and in those with previously undetected ischemic heart disease (3, 4). Patients with silent ischemia have been said to have a defective anginal warning system (5), implying that they are unknowingly at risk. We believe the physician's approach to the phenomenon of silent ischemia should differ substantially depending on whether the patient is known to have coronary artery disease.

Many patients with coronary disease have myocardial infarction or sudden death as the initial presentation of their illness (6). Some of