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[Asymptomatic myocardial ischemia before and after surgical revascularization in patients with multivessel occlusive
D V Kovacevic1, V Topalov, D Kovacević
1Institut za kardiovaskularne bolesti, Sremska Kamenica Medicinski fakultet, Novi Sad, Univerzitetska klinika za kardiovaskularnu hirurgiju.
Insights
Silent myocardial ischemia, or ischemia without symptoms, occurred in 21% of patients post-myocardial revascularization. Early detection via simple tests aids in preventing cardiac events.
Area of Science:
- Cardiology
- Internal Medicine
Context:
- Multivessel occlusive coronary disease poses risks for patients undergoing myocardial revascularization.
- Asymptomatic myocardial ischemia can occur pre- and post-revascularization.
- Early detection of silent ischemia is crucial for preventing cardiac incidents.
Purpose:
- To investigate the incidence of asymptomatic myocardial ischemia after myocardial revascularization in patients with multivessel coronary disease.
- To analyze the characteristics and timing of silent ischemia post-procedure.
Summary:
- A study of 27 patients with multivessel coronary disease undergoing myocardial revascularization found silent myocardial ischemia in 21.6% post-procedure.
- Silent ischemia was most common in the early morning hours and associated with ventricular rhythm disturbances.
- A high prevalence of untreated diabetes mellitus (87.5%) was noted in patients with silent ischemia.
Impact:
- Silent myocardial ischemia is a significant finding post-revascularization, detectable through routine examinations.
- Identifying and treating silent ischemia can improve patient outcomes and prevent future cardiac events.
- Findings highlight the importance of monitoring for silent ischemia, especially in diabetic patients.
Introduction:
The objective of this study was to examine the occurrence of asymptomatic myocardial ischemia prior to and after myocardial revascularization in patients with multivessel occlusive coronary disease. Asymptomatic ischemia can be described as real ischemia without anginal pain or other ischemic symptoms in patients with coronary disease or coronary artery spasm. Our study examined silent ischemia after myocardial revascularization. Early detection of silent ischemia is important for prevention of cardiac incidents.
Material And Methods:
We have examined patients with multivessel coronary disease with occurrence of continued preoperative silent ischemia. All patients have undergone ECG examination, exercise stress test and Holter-monitoring prior to and after myocardial revascularization.
Results:
The investigation comprised 27 patients and their average age was 54.5 years. All patients with silent ischemia had a multivessel occlusive coronary disease and have undergone myocardial revascularization managed with triple or quadruple aortocoronary bypass surgery. Exercise stress test was performed postoperatively in elder patients, as well as ECG and Holter-monitoring. Silent ischemia was established in 21.6% of patients, while in 87.5% untreated diabetes mellitus was diagnosed. Silent ischemia most often occurred in the early morning hours and it was frequently associated with heart rhythm disturbances (VES) whereas these rhythm disturbances depended on the length of the ischemic episode. Intermittent 2nd degree atrioventricular block was found in one patient.
Conclusion:
Silent myocardial ischemia occurred in 21% of patients after myocardial revascularization. It is most often detected in the early morning hours and is associated with ventricular rhythm disorders. Silent ischemia is easily detected by simple examination procedures providing adequate therapy and prevention of cardiac incidents.