Silent ischemia--what should be done?
Gohlke, H.
Schweizerische Medizinische Wochenschrift 124(35): 1515-1519
1994
ISSN/ISBN: 0036-7672 PMID: 7939517 Document Number: 430502
The prevalence of silent, previously undiagnosed, exercise-induced ischemia is between 0.5 und 3.5% in 40-59-year-old men. Its prevalence is dependent upon the prevalence of coronary artery disease in the population or sub-population considered. The pathophysiological mechanism of silent ischemia is extracardiac. The prognosis of silent ischemia is determined by the functional impairement and the extent of coronary artery disease. The decision concerning medical and surgical treatment of patients with silent ischemia is based on the same criteria as in patients with ischemia and angina pectoris: patients at high risk (ischemia at low levels of exercise, marked exercise-induced ischemia, proximal 3-vessel disease and at least moderately impaired left ventricular function) are candidates for invasive treatment. Patients with ischemia at high levels of exercise, or with minimal ischemia with one- or two-vessel disease, are candidates for medical management. The best possible control of all cardiovascular risk factors is mandatory for all patients, from the viewpoint of prognosis in particular.