Q. Silent Myocardial Ischaemia?
Ans.
This deals primarily with those who have never had symptoms recognized as being of cardiac origin. Others, who have had recognized myocardial infection but have been asymptomatic following this event, are commonly believed to be free of ischaemia but limited somewhat by scar tissue replacing function myocardium. In actuality, more than 50 per cent of this group have other vessels significantly narrowed. Although many subjects with silent CAD have a sudden coronary event, the risk of an event is probably less than if ischaemia is associated with typical anginal pain. The risk of an event with asymptomatic ischaemia is about 50 per cent of that when classical angina accompanies the ECG findings during stress testing. When subjects with silent ischaemia are followed up for 5 years, those who convert to classic angina, have a poorer prognosis than those who remain asymptomatic. Even though the patient may come in with no history of chest pain, any type of chest discomfort, upper abdominal gas or bloating, inordinate dysponea with exercise or just increasing fatigue, may be an angina equivalent.