Silent Ischemia

Myocardial ischemia without pain or symptoms is
common in patients with CAD. The incidence of silent
ischemia is high and the outcome unfavorable in patients
with unstable angina. Interventional therapy is often
recommended. Holter monitoring after noncardiac surgery
in patients with stable angina and post myocardial
infarction patients has documented a high incidence of
silent ischemia within the second to fourth day after
surgery.
In the Total Ischemic Burden Bisoprolol Study, both
bisoprolol and nifedipine reduced the number and
duration of transient ischemic episodes. Bisoprolol was
significantly more effective than nifedipine and reduced
the morning peak of ischemic activity. This is in keeping
with other studies, which indicate that beta-blocking drugs
are superior to calcium antagonists in producing salutary
effects in patients with silent ischemia, especially in
reducing early morning ischemia that may relate to the
peak incidence of early morning heart attacks and death.
Patients with evidence of silent ischemia are recommended
to be treated with a beta-blocking drug, aspirin,
and a statin and investigated with exercise stress testing.
Those who show strongly positive exercise tests and/or
ejection fractions less than 45% should be submitted to
coronary angiography for consideration of an appropriate
revascularization procedure.

For more information visit Jigfo.com, the no.1 source of information.