Silent ischemia, its clinical importance as seen in 1989

Silent myocardial ischemia is defined as spontaneous episodes of ischemic equivalents, especially transient ST-segment depression without being accompanied by typical anginal pain. Due to the improved recording possibilities of the T-segment over 24 h, the phenomenon of silent ischemia was widely analyzed in recent years. The special methodological problems and, especially, newer clinical results (duration and daily number of episodes, circadian distribution of episodes) are extensively discussed; this also includes the correlation to coronary anatomy (extension of coronary artery disease) and to exercise testing. The prognostic aspects, and also the resulting therapeutic consequences and indications remain the objects of further studies; this is especially true for the indication for medical anti-ischemic treatment as analyzed by 24-h Holter monitoring.