Myocardial ischemia and chest pain: a misunderstood and oversimplified relationship?

There is a very predictable sequence of events that occurs when there is a critical imbalance in the myocardial oxygen supply/demand ratio. This sequence of events becomes unpredictable when clinical manifestations are considered. Myocardial ischemia is broader in scope than merely angina, and every ischemic episode has severe possible outcomes. The prognosis of any patient with silent ischemia is presumably based on these outcomes.