Silent Myocardial Ischemia: Proceedings of the Symposium on New Drugs and Devices October 15–16, 1987, Philadelphia, Pennsylvania (Developments in Cardiovascular Medicine, 88)

Although some investigators have questioned the importance and even the existence of silent myocardial ischemia, documentation presented at this two day symposium leaves little doubt about its existence and importance. It has been estimated that about 3 million of the estimated 4 million angina sufferers in the United states have frequent episodes of silent myocardial ischemia. Although it is not possible to define how many Americans die due to silent ischemia, it has been suggested that the mortality rate may exceed hundreds of thousands of victims annually. Unfortunately, there still remains a lack of definitive information as to why some ischemic events are painless. Some suggest the concept that the location and size of the myocardium at jeopardy relates to pain, that the pain threshold varies from patient to patient or that there are neurological deficits in the myocardium of some patients with silent ischemia. Abnormalities in myocardial perfusion and function can occur without pain. An interesting observation presented by several investigators has been that when a coronary artery is occluded in man, no ischemic pain is perceived for the first 30 seconds. Only after a 30 second period or so of occlusion does angina occur. An even more confusing observation is that some 30 second periods of occlusion of the same vessel in the same patient results in angina while the next occlusion can be a totally silent event. Front Matter....Pages i-xiii Front Matter....Pages 1-1 Epidemiology and Prevalence of Silent Myocardial Ischemia, and Prognosis in Asymptomatic Patients....Pages 3-5 Pathophysiology of Ischemia: Why are Some Episodes Silent?....Pages 7-15 Myocardial Ischemia as a Useful Functional Indicator of Risk in Patients with Coronary Artery Disease....Pages 17-23 The Diagnostic and Prognostic Value of Exercise ECG and Radionuclide Markers of Ischemia in Asymptomatic and Symptomatic Populations....Pages 25-38 An Integrated Clinical Classification for Ischemic Heart Disease: A Combined Assessment of Severity of Coronary Disease, Left Ventricular Function and Myocardial Ischemia....Pages 39-54 Back Matter....Pages 55-74 Front Matter....Pages 75-75 Methods to Detect Ischemia Using Ambulatory (Holter) Electrocardiography....Pages 77-87 The Prognostic Significance of Silent Myocardial Ischemia During Exercise Testing....Pages 89-92 The Role of Radionuclide Techniques in the Evaluation of Patients with Silent Myocardial Ischemia....Pages 93-106 Back Matter....Pages 107-114 Front Matter....Pages 115-115 Longitudinal (Natural History) Studies of Silent Myocardial Ischemia....Pages 117-130 Silent Myocardial Ischemia and Sudden Cardiac Death....Pages 131-138 Back Matter....Pages 139-143 Front Matter....Pages 145-145 Antianginal Drug Therapy for Silent Myocardial Ischemia: Adrenergic Blockers and Calcium Entry Blockers....Pages 147-161 Therapy For Silent Ischemia: Nitrates....Pages 163-178 What are the FDA Requirements to Obtain a Claim for the Indication of Silent Ischemia?....Pages 179-196 Back Matter....Pages 197-211 Front Matter....Pages 213-213 Combination Drug Therapy: What Studies are Required to Obtain Approval?....Pages 215-220 Back Matter....Pages 221-242