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Silent myocardial ischaemia in patients with angiographically proven coronary artery disease
Insights
Silent myocardial ischemia is more common than symptomatic ischemia in coronary artery disease patients during daily activities. Silent episodes are longer, more frequent, and occur at lower heart rates, as revealed by Holter monitoring.
Area of Science:
- Cardiology
- Internal Medicine
- Diagnostic Monitoring
Background:
- Coronary artery disease (CAD) poses a significant health burden.
- Assessing the total ischemic burden in CAD patients during daily life is crucial for effective management.
- Holter monitoring is a key tool for evaluating cardiac events outside of a clinical setting.
Purpose of the Study:
- To evaluate the total ischemic burden in patients with coronary artery disease (CAD) during daily activities.
- To compare the characteristics of symptomatic versus silent myocardial ischemia.
- To determine the utility of Holter monitoring in assessing ischemia in CAD.
Main Methods:
- Holter monitoring was used to assess 20 patients with angiographically proven coronary artery disease (CAD).
- Ischemic episodes (symptomatic and silent) were recorded and analyzed.
- Data on frequency, duration, heart rate, and timing of ischemic events were collected.
Main Results:
- Thirteen out of twenty CAD patients exhibited ischemia on Holter monitoring.
- Silent myocardial ischemic episodes were more frequent (25 vs. 10), longer (15-53 min vs. 8-45 min), and occurred at lower heart rates (mean 68 vs. 76 bpm) than symptomatic episodes.
- Ischemia occurrence showed no relation to rest, activity, or left ventricular function; evening peaks were as frequent or more than morning peaks.
Conclusions:
- Silent myocardial ischemia is more prevalent than symptomatic ischemia in CAD patients during daily activities.
- Holter monitoring is valuable for assessing the total ischemic burden in CAD.
- Understanding silent ischemia characteristics is vital for comprehensive CAD patient care.
Abstract:
Twenty patients with angiographically proven coronary artery disease (CAD) were evaluated by Holter monitoring for assessment of total ischaemic burden during daily activities. Thirteen patients revealed ischaemia on Holter monitoring (symptomatic-2, silent-4 and both types-7). As compared to symptomatic ischaemia, the silent myocardial ischaemic episodes were more frequent (25 vs 10 episodes), longer in duration (15-53 minutes vs 8-45 minutes), occurred at lower heart rates (65-75/minute (mean 68) vs 70-90 per minute (mean 76) and silent ischaemic episodes exceeded symptomatic ones in both morning (10 vs 4) and evening (15 vs 6) peaks. Occurrence of symptomatic as well as silent ischaemia had no relation to rest, activity, left ventricular functions, and there was no difference in the extent (1-3mm) and type (horizontal or downsloping) of ST-segment depression. We conclude that in patients with significant coronary artery disease, silent myocardial ischaemia is more frequent than the symptomatic ischaemia during daily activities. It occurs at lower heart rates, lasts longer, and bears no relation to rest, activity or left ventricular function. Evening peaks may be as frequent or more than the morning peaks. Holter monitoring thus is helpful for assessment of total ischaemic burden in CAD patients.