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[Practical value of the detection of silent myocardial ischemia in patients with coronary disease using Holters]
1Service de Médecine Interne, CHU Henri-Mondor, Créteil.
Insights
Painless myocardial ischemia has a similar prognosis to symptomatic ischemia. Early detection using Holter monitoring and exercise testing identifies high-risk patients needing further investigation and treatment for coronary artery disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Interventional Cardiology
Context:
- Coronary artery disease (CAD) management.
- Distinguishing between symptomatic and asymptomatic (silent) myocardial ischemia.
- Prognostic implications of painless myocardial ischemia.
Purpose:
- To evaluate the prognosis of painless myocardial ischemia.
- To assess the utility of Holter monitoring and exercise testing in identifying high-risk CAD patients.
- To review treatment strategies for silent myocardial ischemia.
Summary:
- Painless myocardial ischemia shares a similar prognosis with symptomatic ischemia.
- Holter monitoring combined with exercise testing effectively identifies high-risk patients with silent ischemia.
- Further investigations like thallium scans and coronary arteriography, along with interventions such as angioplasty or bypass surgery, may be necessary for these high-risk individuals.
Impact:
- Highlights the importance of detecting silent ischemia for risk stratification in CAD patients.
- Informs clinical decision-making regarding further investigations and aggressive treatment for high-risk individuals.
- Underscores the current uncertainty in drug treatment efficacy for preventing adverse events in silent myocardial ischemia.
Abstract:
The prognosis of painless myocardial ischemia is similar to that of symptomatic ischemia. The Holter technique (and solid memory Holter in particular) is a simple method of detection which, taken together with exercise testing, enables the identification among coronary disease patients of a high risk group in whom effort ischemia is accompanied by episodes of ischemia under everyday conditions and in whom additional investigations (exercise thallium scan then coronary arteriography) and appropriate treatment, including transluminal angioplasty and aorto-coronary bypass if necessary, may be required. The role of drug treatment in silent ischemia has not yet been clearly defined. While electrical ischemia regresses significantly with the majority of standard drug regimens, and beta-blockers in particular, none has yet been confirmed as having a preventive effect against serious events following on from silent myocardial ischemia.