Clinical outcome of silent myocardial ischemia

Stern, Shlomo; Gavish, Alex; Zin, Dan; Tzivoni, Dan

doi:10.1016/0002-9149(88)90049-5

Cited by 16 publications

(6 citation statements)

References 22 publications

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“…These figures are considerably higher than those reported for younger patients. Stern and coworkers 10 reported a 30% incidence of cardiac events during a 2‐year follow‐up in a younger group of patients with known coronary artery disease and silent ischemia, compared with an 11% recurrence of ischemic events in the group without silent ischemia. The higher incidence of coronary events in elderly patients with silent ischemia may well reflect the fact that these patients have multivessel coronary disease of advanced degree.…”

Section: Myocardial Ischemiamentioning

confidence: 99%

Clinical Manifestations of Acute Myocardial Infarction in Older Patients

Gregoratos

2001

American J Geri Cardiology

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Coronary artery disease is the major cause of morbidity and mortality in the elderly in the United States. In this age group, the clinical presentation of coronary heart disease can be quite atypical. In general, the incidence of typical precordial chest pressure/pain denoting myocardial ischemia is less common, whereas dyspnea as an anginal-equivalent symptom is frequent. The diagnosis of ischemic cardiac pain is frequently confused by the many comorbid conditions present in the elderly. Even when classic ischemic precordial discomfort is present, it tends to be less severe and less well defined. The elderly appear to have reduced pain perception; as a result, silent myocardial ischemia is more common and carries a somewhat worse prognosis in the elderly than in younger age groups. Similarly, the presenting symptoms of acute myocardial infarction in the elderly can be nonspecific. The classic crushing substernal chest pain decreases with age, whereas the symptom of dyspnea gradually increases. Neurologic symptoms, confusional states, weakness, and worsening heart failure are common clinical presentations of an acute infarction in elderly patients. Silent (unrecognized) myocardial infarctions are common in the elderly and carry serious prognostic implications.

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Section: Myocardial Ischemiamentioning

confidence: 99%

Clinical Manifestations of Acute Myocardial Infarction in Older Patients

Gregoratos

2001

American J Geri Cardiology

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“…In-hospital ischemic events occurred in 14 of 27 patients (52%) with silent myocardial ischemia compared with 7 of 32 patients (22%) without silent ischemia. Stem et al [70] demonstrated by AECG during daily activities that at 2-year follow-up, 23 of 76 patients (30%) with prior MI with myocardial ischemia had cardiac events com pared with 15 of 135 patients ( 11 %) with prior MI with out ischemia. Tzivoni et al [71] showed that 74 of 224 low-risk post-MI patients (33%) had myocardial isch emia detected by AECG.…”

Section: Aecg For Detection Of Myocardial Ischemiamentioning

confidence: 99%

“…The ACC/AHA Task Force considered performing an AECG to detect myocardial ischemia for risk prediction in patients with known CAD, anterior MI, and stable or unstable angina when combined with confirmatory stress testing a class II indication [6], The prognostic value of silent myocardial ischemia detected by AECG has been reported in patients with unstable angina [63,64,67], in post-MI patients [68][69][70][71], in patients with sta ble CAD [62,70,[72][73][74], in patients following coronary artery bypass graft surgery [75,76], and in patients with hypertension, valvular heart disease, or cardiomyopathy [62], Silent myocardial ischemia detected by AECG per sisting after medical therapy of unstable angina is associ ated with an adverse short-term and 2-year prognosis [63,64,67]. Gottlieb et al [63] documented at 1-month follow-up in patients with unstable angina treated medi cally that new coronary events occurred in 16 of 37 patients (43 %) with silent myocardial ischemia and in 4 of 33 patients (12%) without silent ischemia.…”

Section: Aecg For Prognosis Of Myocardial Ischemiamentioning

confidence: 99%

“…At 6-to 12-month follow-up, clinical symptoms worsened in 16 of 37 pa tients (43 %) with myocardial ischemia compared with 3 of 43 patients (7%) without myocardial ischemia. Stern et al [70] showed by AECG during daily activities that at 2-year follow-up, 26 of 86 CAD patients (30%) with no prior MI with myocardial ischemia had cardiac events compared with 8 of 59 CAD patients (14%) with no pre vious MI and no ischemia. Rocco et al [73] demon strated myocardial ischemia by AECG in 49 of 86 patients (57%) with stable CAD.…”

Section: Aecg For Prognosis Of Myocardial Ischemiamentioning

confidence: 99%

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Ambulatory Electrocardiographic Monitoring

Aronow¹

1989

Am J Noninvas Cardiol

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Clinical indications for performing 24-hour ambulatory electrocardiography (AECG), recorders, and analysis systems are discussed in this review article. AECG may be useful in detecting whether cardiovascular or neurological symptoms are due to ventricular or supraventricular arrhythmias, bradyarrhythmias, or conduction disturbances. AECG may be useful in assessing arrhythmias or conduction disturbances seen on a 12-lead ECG, in assessing pacemaker function, in detecting arrhythmias in patients with chronic obstructive pulmonary disease, in assessing efficacy of antiarrhythmic therapy, and in detecting arrhythmias induced by antiarrhythmic drugs. AECG may be useful in assessing risk of future cardiac events from arrhythmias in numerous cardiac conditions. AECG may be useful in assessing RR intervals in sleep apnea and in visceral diabetic neuropathy and in assessing RR interval variability as a prognostic sign in patients with coronary artery disease (CAD). AECG may be useful in determining whether chest pain is due to Prinzmetal’s angina, in detecting silent myocardial ischemia during daily activities in patients with known CAD, in detecting myocardial ischemia in patients with suspected CAD who are unable to perform treadmill or bicycle exercise, and in assessing efficacy of antiischemic therapy. AECG detection of myocardial ischemia may be useful in assessing risk of subsequent cardiac events in patients with unstable angina pectoris, in postmyocardial infarction patients, in patients with stable CAD, and in patients with hypertension, valvular heart disease, or cardiomyopathy. The American College of Cardiology/American Heart Association Task Force Class I and Class II indications for performing AECG are also stated.

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“…5 It is also an independent predictor for development of cardiac events in patients with hypertension and may be a predictor of sudden death. 6 Several studies have shown silent ischaemia occurring for 30-60 min over a 24-h period to have adverse clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Postprandial silent ischaemia following a fatty meal in patients with recently diagnosed coronary artery disease

et al. 2000

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Silent myocardial ischaemia (SI) is recognised as an important prognostic factor in patients with coronary artery disease (CAD). Postprandial angina is related to severity of CAD. The effect of postprandial metabolic changes in the pathogenesis of SI is unclear. We studied the postprandial changes in glucose, insulin and triglyceride, and non-esterified fatty acids (NEFA) in relation to postprandial SI and exercise capacity, in patients with CAD. Forty elderly volunteers (63 ؎ 1 years) mean age ؎ s.e.m., with a history of angina were selected on the basis of a Rose questionnaire and a positive exercise stress test (modified Bruce protocol). The test meal contained 45% fat. The meal was consumed at 9.00 am and hourly blood samples were taken for glucose, insulin, triglyceride and NEFA. Continuous Holter monitoring for SI was conducted using a Space-

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Clinical outcome of silent myocardial ischemia

Cited by 16 publications

References 22 publications

Clinical Manifestations of Acute Myocardial Infarction in Older Patients

Clinical Manifestations of Acute Myocardial Infarction in Older Patients

Ambulatory Electrocardiographic Monitoring

Postprandial silent ischaemia following a fatty meal in patients with recently diagnosed coronary artery disease

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