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Painless myocardial ischemia
Last reviewed: 17.10.2021
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In patients with angina pectoris and / or spontaneous angina pectoris (including unstable angina ) up to 50-75% of episodes of myocardial ischemia are painless (asymptomatic, "mute"). It can be said that painless myocardial ischemia is the most common manifestation of coronary heart disease. However, in completely asymptomatic individuals, episodes of painless ischemia ("isolated" painless ischemia, as the only manifestation of IHD) are rarely recorded (about 5% of those surveyed).
[Diagnosis of painless myocardial ischemia
It is possible to detect the presence of painless ischemia only with the help of instrumental research methods, most often use a test with physical activity and ECG monitoring. A sign of painless ischemia is a horizontal or skewed depression of the ST segment. The duration of recording the ST segment depression during ECG monitoring should exceed 1 min. There is even a variant of painless ischemia without changes on the ECG - "hidden", "secret", "supernemaya" ("clandestine") ischemia, which is detected by scintigraphy of the myocardium.
In approximately 25% of cases, the reduction of coronary blood flow, probably due to coronary vasoconstriction, is of primary importance. Often, the appearance of signs of painless ischemia occurs during intense mental activity, psycho-emotional stress, smoking. The clinical and prognostic significance of episodes of painless myocardial ischemia is about the same as angina pectoris. The likelihood of complications and prognosis are determined by the degree of coronary artery and myocardial lesion, and not by the severity of the pain syndrome or the magnitude of the ST segment deviation. It is proved, for example, that the detection of painless ischemia in patients with unstable angina is a very unfavorable prognostic sign.
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Prognosis and treatment of painless myocardial ischemia
Several studies have been carried out to determine whether the elimination of painless ischemia can improve the prognosis in patients with IHD. The results of these studies are contradictory, but more data are in favor of the need for treatment of painless ischemia. Beta-blockers are the most effective. It has been shown, for example, that in the treatment of painless ischemia, atenolol is more effective than placebo, and bisoprolol is more effective than long-acting forms of nifedipine.