scholarly journals A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature

2013 ◽  
Vol 2013 ◽  
Author(s):  
M S Draman ◽  
H Thabit ◽  
T J Kiernan ◽  
J O'Neill ◽  
S Sreenan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischaemia ◽  
Annual Review ◽  
List Type ◽  
Silent Myocardial Ischaemia ◽  
Objective Evidence ◽  
Patients With Diabetes ◽  
Artery Disease

Summary Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes. Learning points Silent myocardial ischaemia (SMI) is an important clinical entity. SMI is common and occurs with increased frequency in patients with diabetes. SMI is an independent predictor of mortality. Recognition may lead to early intervention.

scholarly journals Old unsolved problems: when and how to treat silent ischaemia

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L82-L85
Author(s):  
Ciro Indolfi ◽  
Alberto Polimeni ◽  
Annalisa Mongiardo ◽  
Salvatore De Rosa ◽  
Carmen Spaccarotella
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischaemia ◽  
Holter Monitoring ◽  
Silent Myocardial Ischaemia ◽  
Objective Evidence ◽  
Silent Coronary Artery Disease ◽  
Patients With Diabetes ◽  
Artery Disease ◽  
Worse Prognosis

Abstract Silent myocardial ischaemia (SMI) is defined as objective evidence of ischaemia without angina (or equivalent symptoms) in the presence of coronary artery disease, differing from silent coronary artery disease. Silent myocardial ischaemia represents the majority of episodes of myocardial ischaemia at Holter monitoring. During transient myocardial ischaemia, the symptoms appear after the contraction anomalies of the left ventricle and after the ECG changes. The cause of silent myocardial ischaemia is still not well established. The severity and duration of ischaemia have been theorized as important elements in the SMI mechanism. Another possible mechanism responsible for SMI is represented by changes in the perception of painful stimuli with an increased pain threshold. Finally, a neuronal dysfunction of the diabetic, in post-infarction or a cardiac neuronal ‘stunning’ could play a role in SMI. In the pre-stent era, the SMI was associated with a worse prognosis. In patients with diabetes mellitus, SMI seems to be more represented because autonomic dysfunction is present in this category of patients. In conclusion, SMI is more frequent than symptomatic ischaemia. However, despite the presence of countless studies on the subject, it is not clear today whether medical therapy has equalized the risk and what the real prognosis of SMI is.

scholarly journals Extent of coronary artery disease is associated with myocardial infarction and mortality in patients with diabetes mellitus [Response to Letter]

2019 ◽  
Vol Volume 11 ◽  
pp. 721-722 ◽  
Author(s):  
Kevin Kris Warnakula Olesen ◽  
Christine Gyldenkerne ◽  
Morten Madsen ◽  
Troels Thim ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Patients With Diabetes ◽  
Artery Disease

Incidence of ventricular arrhythmias during silent myocardial ischaemia in coronary artery disease

1996 ◽  
Vol 57 (1) ◽  
pp. 61-67 ◽  
Author(s):  
F. Parthenakis ◽  
G. Kochiadakis ◽  
E. Simantirakis ◽  
E. Zuridakis ◽  
S. Chrysostomakis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischaemia ◽  
Ventricular Arrhythmias ◽  
Silent Myocardial Ischaemia ◽  
Artery Disease

scholarly journals Extent of coronary artery disease is associated with myocardial infarction and mortality in patients with diabetes mellitus

2019 ◽  
Vol Volume 11 ◽  
pp. 419-428 ◽  
Author(s):  
Christine Gyldenkerne ◽  
Kevin Kris Warnakula Olesen ◽  
Morten Madsen ◽  
Troels Thim ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Patients With Diabetes ◽  
Artery Disease

scholarly journals Silent Myocardial Ischaemia: A Review of the Literature for Prehospital Care Providers

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Ziad Nehme ◽  
Malcolm Boyle
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischaemia ◽  
Prehospital Care ◽  
Care Providers ◽  
Inclusion Criteria ◽  
Silent Myocardial Ischaemia ◽  
Prehospital Management ◽  
Artery Disease ◽  
Asymptomatic Coronary Artery Disease

Introduction There has been little emphasis in paramedic education about silent myocardial ischaemia, its implications, and management in the prehospital environment. There is also inadequate information about the aetiology and prehospital management of silent myocardial infarction. The objective of this study was to review the literature on silent myocardial ischaemia and determine appropriate prehospital management. Methods A review of the Medline database was conducted from 1950 to the beginning of March 2007. Inclusion criteria were, any study type reporting the epidemiology, pathophysiology, clinical concepts, and management of silent myocardial ischaemia. References of relevant articles were also reviewed. A review of prehospital clinical implications and management was also undertaken. Results The search yielded 1,332 articles; 110 articles met the inclusion criteria with another 32 articles located from review of relevant articles reference list. Silent myocardial ischaemia is not limited to patients with significant coronary artery disease or cardiovascular risk profiles, it may affect up to 10% of patients with asymptomatic coronary artery disease. Silent myocardial ischaemia is also associated with greater adverse outcomes, and has been defined as the single strongest factor attributing to cardiac death in patients with concurrent angina pectoris. All patients with coronary artery disease presenting with and without pain can be managed with GTN and aspirin, in the absence of contra-indications. Conclusion This study demonstrates that silent myocardial ischaemia is not limited to patients with significant cardiovascular risk profiles and may affect up to 10% of patients with asymptomatic coronary artery disease. There is little prehospital care providers can achieve with current clinical practice guidelines and management regimes.

Silent Myocardial Ischaemia in Patients with Coronary Artery Disease

1988 ◽  
Vol 74 (s18) ◽  
pp. 30P-31P
Author(s):  
D Mulcahy ◽  
J Keegan ◽  
A Quyyumi ◽  
C Wright ◽  
P Crean ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischaemia ◽  
Silent Myocardial Ischaemia ◽  
Artery Disease
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