[The functional characteristics of patients with the silent form of ischemic heart disease]

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.