Silent myocardial ischemia: pathophysiology and perioperative management

Silent ischemia has been called the silent killer. Pain does not kill patients with coronary heart disease--ischemia does, whether it happens to be painful or silent. An increased awareness of this still puzzling phenomenon may be of great importance in the pre- and perioperative management of patients with coronary heart disease, and improved detection and management of silent ischemia are likely to reduce the risk of perioperative cardiac events.