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Should we treat silent ischaemia?

¹National Heart Hospital, London, U.K.

Journal of Cardiovascular Pharmacology

|January 1, 1987

Summary

Silent myocardial ischemia, indicated by ST-segment depression without chest pain, shows similar hemodynamic changes to symptomatic episodes. Treatments reduce both painful and painless ischemia, but prognosis impact requires further study.

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Area of Science:

Cardiology
Internal Medicine

Background:

Ambulatory monitoring of ST segments in angina patients reveals ST-segment depression occurs with or without chest pain.
Approximately one-third of ST-segment depression episodes are symptomatic.

Purpose of the Study:

To investigate the significance of ST-segment changes during myocardial ischemia, particularly in the absence of chest pain.
To evaluate the impact of treatments on both symptomatic and asymptomatic ST-segment depression.

Main Methods:

Utilizing 24-hour ambulatory ST-segment monitoring.
Employing hemodynamic studies and nuclear imaging.
Conducting ambulatory pulmonary artery monitoring.

Main Results:

ST-segment depression, whether symptomatic or silent (painless), is associated with hemodynamic alterations, including increased left ventricular filling pressure and pulmonary artery diastolic pressure.
Treatments like antianginal drugs, angioplasty, and surgery effectively reduce both painful and painless ST-segment changes.

Conclusions:

Silent myocardial ischemia, characterized by ST-segment depression without pain, exhibits significant hemodynamic changes comparable to symptomatic episodes.
While treatments reduce the frequency of silent ischemia, further research is needed to ascertain if this improves patient prognosis.

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