[Silent myocardial ischemia].

Silent or painless myocardial ischaemia is common: it can occur in totally asymptomatic patients, in stable or unstable angina sufferers, or after infarction. In most instances, it is detected electrocardiographically (or ambulatory recording by treadmill test). It is essential to establish a firm diagnosis because patients are high-risk subjects. Tomoscintigraphy or echocardiography, on exertion or after drug stimulation, are therefore to be used before it is decided to perform coronary angiography. In all cases treatment is required to suppress ischaemia. It should primarily be medical, the choice being governed by the results of exploration, and should bear upon anatomical lesions and their functional effects. Revascularization, generally by angioplasty, is thus increasingly indicated despite the fact that, in contrast to painful ischaemia, there are no comparative studies available on painless ischaemia to help guiding the treatment decision.