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[The functional characteristics of patients with the silent form of ischemic heart disease]
Insights
Painless ischemic heart disease (IHD) and atypical pain syndromes are common. Threshold exercise levels are higher in patients without angina, indicating potential underdiagnosis of painless myocardial infarction (PMI).
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Ischemic heart disease (IHD) presents with diverse clinical forms, including painless presentations.
- Painless myocardial infarction (PMI) and atypical pain syndromes pose diagnostic challenges.
- Understanding exercise tolerance and diagnostic test utility is crucial for managing IHD.
Purpose of the Study:
- To evaluate exercise tolerance in patients with different forms of IHD.
- To assess the diagnostic value of various tests in identifying IHD.
- To investigate the prevalence and characteristics of painless myocardial infarction (PMI).
Main Methods:
- Studied 124 patients with ischemic heart disease (IHD).
- Assessed threshold exercise levels and compared them across patient groups.
- Utilized stress tests, cold tests, hyperventilation tests, and 24-hour ECG monitoring.
- Analyzed angiogrammes in patients with atypical pain syndromes.
Main Results:
- Patients without angina pectoris (including postinfarction cardiosclerosis) had higher exercise tolerance than those with angina or silent ischemia.
- Stress tests were positive in 42.8%, cold tests in 6.3%, and hyperventilation tests in 16.8% of patients.
- Painless myocardial infarction (PMI) was detected in 50% of patients with postinfarction cardiosclerosis and 63.6% of those without prior myocardial infarction via 24-hour ECG monitoring.
- Significant coronary artery injury (57.1%) and coronary artery spasm (33.3%) were found in patients with atypical pain syndromes.
Conclusions:
- Painless myocardial infarction (PMI) occurs across various IHD forms, even in patients without current chest pain.
- Exercise tolerance may not accurately reflect disease severity in painless IHD presentations.
- Diagnostic strategies should consider the high prevalence of PMI in patients with seemingly mild or atypical IHD symptoms.
Abstract:
A total of 124 patients with ischemic heart disease (IHD) were studied. Of these, 53 presented with painless IHD form, 28 patients had atypical pain syndrome. It has been shown that the threshold exercise level both in those persons free from angina pectoris but with postinfarction cardiosclerosis and those with no history of myocardial infarction is not significantly different from and is appreciably higher than in IHD patients with angina pectoris and episodes of "silent ischemia". Informative value has been studied of other diagnostic tests in the above patients: stress-test appeared to be positive in 42.8% of patients, cold test--in 6.3%, hyperventilation test in 16.8% of patients. Painless myocardial infarction (PMI) was detected in 50% of patients with postinfarction cardiosclerosis and 63.6% with no history of myocardial infarction, as evidenced by 24-h ECG monitoring. Analysis of angiogrammes in those persons with atypical pain syndrome showed hemodynamically significant injury to the coronary vessels in 57.1% of patients and a spasm of coronary vessels in 33.3%. PMI occurs in patients with different IHD forms including those with prior MI free from stenocardia.