Reviews Silent Myocardial Ischemia: Invisible Part of the Iceberg

Silent miyocardial ischemia is a common presentation of coronary insufficiency. The cause(s) is stil unknown. Documentation is generally obtained by exercise electrocardiogram or Holter monitoring, as well as by radionuclide techniques (e.g. thallium 201 myocardial scintigraphy). Silent myocardial ischemia has the same consequences as symptomatic ischemia on myocardial perfusion and ventricular function, and different studies showed that prognosis of silent myocardial ischemia is similar to the patient with symptomatic ischemia. Therefore, the clinician should treat not only angina but any myocardial ischemia. Various methods of treatment include correction of coronary risk factors, betablockers and/or calcium channel blockers, coronary angioplasty, and bypass surgery, especially in high risk patients.