Silent ischaemia

Generally, the clinical presentation of myocardial ischaemia is the characteristic pain known as angina pectoris or some equivalents (e.g. dyspnoea), although sometimes ischaemia may be silent (see Silent ischaemia , p. 302). If the anginal pain is new or if it has increased with respect to previous discomfort (crescendo angina), this constitutes the clinical condition called acute coronary syndrome (ACS), which may evolve into myocardial infarction (MI) (see Section Acute coronary syndrome , p. 209). If the angina pain appears with exercise... 

There is no doubt that silent ischaemia, a term introduced by Stern and Tzivoni (1974), exists and represents lack of myocardial perfusion before the presence of pain or equivalents (Nesto and Kowal-druk, 1987) (ischaemic cascade - Figure 12.1). It is frequently seen in both patients with ACS and those with chronic IHD (Cohn, 1980, 2001 Cohn, Fox and Daly, 2003 Deanfield et at, 1984 Stern, 1998 Stern and Tzivoni, 1974). 

Silent ischaemia is present in different clinical setting of IHD. We have already commented that... 

Boon D, Piek JJ, van Montfrans GA Silent ischaemia and hypertension. J Hypertens 18(10) 1355-1364,... 

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