Silent Myocardial Ischemia
Silent Myocardial Ischemia
September 27, 2013
3rd Dubrovnik Cardiology Highlights
Milwaukee Calatrava Art Museum
David Gutterman, MD Senior Associate Dean for Research
Northwestern Mutual Professor Of Cardiology
Medical College of Wisconsin Milwaukee, WI
Medical College of Wisconsin
- Clinical Entity of Silent Myocardial Ischemia ? Magnitude of the Problem - Mechanism of Cardiac Pain and of Silent Ischemia - Prognostic importance of Silent Myocardial Ischemia
- Disclosures: Grant funding from NIH
Paradox
- Coronary disease is the #1 cause of death world-wide.
- We have reduced the death rate from CAD dramatically over the last 50 years (>50% reduction)
Why is it still the #1killer?
Presenting Diagnoses of Patients With Coronary Artery Disease
Sudden Death
Myocardial Infarction
Angina Pectoris
Symptoms among 48 patients with witnessed sudden cardiac arrest
chest pain/ dyspnea abdominal pain No symptoms
63%
27%
10%
The most common symptom of myocardial ischemia:
absence of symptoms
-Farb et. al., Circ. 1995
Silent Myocardial Ischemia
"Objective evidence for myocardial ischemia without angina or anginal equivalents in a patient with coronary artery disease or coronary spasm."
- Carl Pepine
- Not the same silent coronary disease
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