[Silent myocardial ischemia in diabetics]

The present communication deals with knowledge gained at detecting episodes of silent myocardial ischaemia in a group of diabetics with a positive load ECG test. With the recent advance of new examination methods it becomes evident that the asymptomatic transitional defects of perfusion or myocardial function in patients with ischaemic heart disease are apparently the most frequent ischaemic accidents which the patient experiences during his or her usual daily activity. They are not caused by increased demands on oxygen supply by the myocardium, rather it is the case of decreased oxygen supply due to dynamic changes in arterial blood supply of the myocardium during transient arterial vasoconstriction. These accidents are markedly more frequent in diabetic patients in whom an earlier and more severe development of ischaemic heart disease occurs. Associated are also specific changes in autonomous nerve fibres conducting pain, which shift a number of ischaemic episodes to the asymptomatic form.