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OBJECTIVE--Diabetes is associated with oxidative stress and increased mortality, but a possible correlation between leukocyte-endothelium interactions, oxidative stress, and silent myocardial ischemia (SMI) is yet to be confirmed. RESEARCH DESIGN [...]

OBJECTIVE--Slow heart rate recovery (HRR) predicts all-cause mortality. This study investigated the relationship between silent myocardial ischemia (SMI) and HRR in type 2 diabetes. RESEARCH DESIGN AND METHODS--The study enrolled [...]

The incidence of coronary artery disease and myocardial ischemia remains high among the elderly. Symptoms, such as chest pain and the prevalence of coronary diseases vary significantly with age. In treating an elderly patient, several physical, emotional and environmental risk factors should be studied. Nitrates, beta-adrenergic drugs and calcium channel blockers are the mainstays of drug therapy and can be used in combination for best results. Anti-platelet therapy with low-dose aspirin may also be of use. Asymptomatic ischemia can also be treated with the same drug regimen but its prognosis is comparatively worse.

Recently, a reader asked about 'silent' heart attacks, a common but, unfortunately, little-understood health threat to Americans. She wrote, My husband's doctor told him he ma have had a silent [...]

During exercise radionuclide ventriculography, many patients with coronary artery disease exhibit painless myocardial ischemia defined as an abnormal left ventricular ejection fraction response without accompanying angina. To see if complete suppression of such exercise-induced painless ischemia by anti-ischemic medication implies a better prognosis in medically treated coronary artery disease, 34 patients underwent repeat testing at 4 weeks receiving regular conventional therapy that rendered angina no worse than class I. With such therapy, painless ischemia was abolished in 12 patients (group I) and persisted in 22 (65%, group II). Both groups were similar in age, number of diseased vessels, proportion with previous myocardial infarction, exercise ejection fraction, and degree of exercise-induced painless ischemia at baseline. At 9 months, adverse events had occurred in 11 patients (2 patients with myocardial infarction, 4 with unstable angina, 2 with angioplasty and 3 with bypass surgery). Only 1 of 12 patients (8%) in group I had experienced events compared with 10 of 22 (45%) in group II (chisquare, 5.4; p

In recent years there has been a significant increase in the use of percutaneous transluminal coronary angioplasty (PTCA, a method of treating localized coronary artery narrowing with a catheter and a balloon). This is due in part to increased availability of the technique and an improvement in the identification of patients for whom PTCA is an effective treatment. Prior to therapeutic intervention the potential benefits and success of PTCA, and the relative risk of further illness or death must be established. PTCA is one of the primary treatments for myocardial ischemia, or inadequate supply of blood and oxygen to the heart muscle. However, in cases of silent ischemia when patients are asymptomatic, the advisability of this technique is still uncertain. Previous studies have concluded that under certain conditions, PTCA is recommended for asymptomatic individuals. Factors such as the location and extent of the coronary narrowing, left ventricular dysfunction, and the results of exercise capacity tests should all be considered. There is a small proportion of patients with silent myocardial ischemia who do not clearly fall into either category and for whom positive results from PTCA cannot be predicted. Reference is made to an article by Anderson et al. in the January 1990 American Journal of Cardiology that discussed the effects of PTCA on 114 asymptomatic patients. A high success rate was achieved with this group, but other studies of similar populations indicate that untreated or medically treated patients had similar incidents of myocardial infarctions (heart attacks). The Anderson article supports the safety of PTCA, but as yet no clear criteria for its use in asymptomatic patients have been determined.