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1.
Silent ischemia after myocardial infarction has definite prognostic significance but should be interpreted within the context of other prognostic indicators. The rationale for therapeutic intervention is based on the prognostic implications of silent ischemia and the potentially deleterious effect of repeated episodes of ischemia on the integrity of the left ventricle. We measured parameters of ischemia in 20 patients who showed asymptomatic ischemic ST-T changes on exercise testing in the early phase after myocardial infarction. After diltiazem administration, a reduction of exercise-induced ST-T depression from 2.3 +/- 0.8 to 0.7 +/- 0.6 mm (p less than 0.01) occurred, and regional wall-motion score at exercise, determined by radionuclide angiography, improved significantly (p less than 0.02). These and other observations warrant further studies in which the duration, severity and frequency of the ischemic episodes should be quantified and correlated with prognosis after myocardial infarction.  相似文献   

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Silent myocardial ischemia   总被引:1,自引:0,他引:1  
Cohn PF  Fox KM  Daly C 《Circulation》2003,108(10):1263-1277
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Silent myocardial ischemia seems a relatively frequent manifestation of coronary insufficiency. The practice of more and more sophisticated tests to detect myocardial ischemia shows that it is a relatively frequent pathological occurrence. It occurs in patients with an abnormality or a transient or constant failure of the alarm system, represented by pain during the ischemia. It is an heterogenous picture which may take the appearance of a completely silent ischemia (the metabolic, hemodynamic and electrical consequences of ischemia being the only symptoms of coronary insufficiency, demonstrated by the presence of severe, angiographic or anatomical, stenoses); of a silent transient ischemia (with alternance of symptomatic and silent episodes or with silent episodes after myocardial infarction); of myocardial necroses without pain or ischemic myocardiopathies. It is the consequences of either an ischemia which is too moderate to reach the pain threshold, or a severe ischemia in patients presenting alterations of the transmission system and of the perception of pain. It has metabolic, hemodynamic and anatomical consequences which may lead to necrosis or degeneration and fibrosis of the myocardium. The prognosis of a painless disease is difficult to make but it does not seem to be as poor as the one of the usual forms of ischemic cardiopathies. Medical treatment is mandatory, and surveillance of its efficacy must be systematic using the techniques of detection of the ischemia.  相似文献   

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Silent myocardial ischemia   总被引:3,自引:0,他引:3  
Silent myocardial ischemia has emerged from a subject of mainly research interest to one with important clinical implications for practicing physicians. Although the pathophysiologic mechanisms responsible for the absence of pain are still not clear, it is apparent that episodes of silent myocardial ischemia are frequent and occur in many patients with coronary artery disease; episodes occur both in asymptomatic and symptomatic patients; episodes are detectable by various noninvasive and invasive techniques; and episodes appear to have important prognostic implications when combined with the extent of anatomic disease and degree of left ventricular dysfunction. It is expected the rapidly accumulating prognostic data, especially in patients after infarctions and patients with unstable angina, will have a profound effect on the way physicians treat their patients with coronary artery disease.  相似文献   

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Ambulatory outpatient monitoring of patients with angina suggests a different view of myocardial ischemia than is conventionally obtained from in-hospital tests. Multiple episodes of ST segment depression occur, and the majority of these disturbances are not associated with symptoms. Recently, studies of regional myocardial perfusion using the technique of positron emission tomography with rubidium 82 have confirmed the ischemic nature of these silent ST changes. Furthermore, activities of everyday life such as mental stress or cold exposure seem to provoke both symptomatic and asymptomatic ischemia, as judged by ST depression and reduced cation uptake. This report presents an unusual case of silent myocardial ischemia observed during the chewing of food.  相似文献   

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无痛性心肌缺血与炎症   总被引:1,自引:0,他引:1  
尽管疼痛阈值的个体差异可部分解释痛觉的差异性,但日常活动或者劳累、情绪激动后的无痛性心肌缺血(silent myocardial ischemia,SMI)的确切发生机制尚不明确。部分研究者提出疼痛缺失的原因是预警机制的缺陷,强调患者之间疼痛敏感性的差异。也有学者认为可能与中枢神经系统和外周神经末梢的病理改变相关。  相似文献   

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OBJECTIVE: Our objective was to determine the presence of silent myocardial ischemia and the degree of coronary obstructions. DESIGN: Successively patients with myocardial infarction. SETTING: Patients admitted to the coronary intensive care, later followed in a specialised out-patients consultation. PATIENTS: 62 patients with previous myocardial infarction. INTERVENTIONS: All the patients were submitted to Holter-monitoring and coronary angiography. RESULTS: Silent ischemia was present in 14 (22,6%) of the patients. Seven of these (50%) had 3 vessels disease, 2 (14,3%) had 2 vessels disease, and 5 (35,7%) had 1 vessel disease. Twelve of the patients (86%) had occlusive lesions (greater than 90%), localised in 11 (79%) in the third proximal segment of the artery. CONCLUSIONS: Our results showed that the presence of silent myocardial ischemia was predominantly associated with 3 vessels disease, and with lesions of more than 90% of occlusion, localised in the 1/3 proximal of the vessel. Patients with previous myocardial infarction and silent ischemia may belong to a subgroup with surgical indication. And so, Holter studies in these patients should be followed by angiographic studies for localization of the obstructive lesions.  相似文献   

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Silent myocardial ischemia is now in its fourth decade of recognition as a clinical syndrome within the spectrum of coronary artery disease. Prior decades have seen important research into the pathophysiology, detection, prevalence, prognosis, and therapy of this syndrome. More recent developments have continued to add data to each of these areas, with particular emphasis on the comparative value of various diagnostic procedures and the effect of therapy on prognosis. While controversy still exists concerning proper screening guidelines for the asymptomatic population, there is a growing consensus that some form of stress testing in high-risk individuals (ie, those with multiple coronary risk factors) is appropriate.  相似文献   

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Coronary angiography enables to determine the true frequency of silent myocardial ischemia (SMI) and specify its prognostic value. Three types of populations are studied. First, patients who are completely asymptomatic and without any past history. The prevalence of coronary disease in this group depends on the age and varies between 2 and 12 p. cent. Then patients with a known coronary insufficiency (past history of myocardial necrosis, for instance). After infarction, in 100 patients evaluated, 50 are asymptomatic and, however, half of them present a SMI. Among those, coronary angiography discloses pluritruncular lesions in half of the cases. And finally, patients with diffuse myocardial disease. 14 p. cent of primary myocardiopathies are of ischemic origin, with diffuse coronary lesions and a severe prognosis.  相似文献   

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Silent myocardial ischemia: concepts and controversies   总被引:5,自引:0,他引:5  
Silent myocardial ischemia is a relatively common, but poorly understood, clinical entity. The most accurate means of detecting silent myocardial ischemia and the precise treatment endpoints remain unclear. However, the amount of ischemic myocardium appears to correlate with the likelihood of future adverse cardiac events. Evidence suggests that patients at highest risk of severe myocardial ischemia, even in the absence of symptoms, derive the greatest benefit from an aggressive diagnostic and therapeutic approach. This paper reviews the diagnosis and treatment of silent myocardial ischemia, and its clinical implication in select patient groups: those without coronary artery disease, those with coronary artery disease, diabetic patients, postrevascularization patients, and women.  相似文献   

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