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Symptoms and Signs of Myocardial Ischemia

  • Chapter
Stress Echocardiography

Abstract

A transient regional imbalance between oxygen supply and demand usually results in myocardial ischemia, the signs and symptoms of which can be used as a diagnostic tool [1]. Myocardial ischemia results in a typical “cascade” of events in which the various markers are hierarchically ranked in a well-defined time sequence [2]. Flow heterogeneity, especially between subendocardial and subepicardial perfusion, is the forerunner of ischemia, followed by metabolic alterations, diastolic dysfunction, induced systolic dysfunction, and only at a later stage electrocardiographic changes, global left ventricular dysfunction, and pain (Fig. 3.1). The ideal marker of ischemia should provide absolute values of sensitivity and specificity, as well as a diagnosis of the site and severity of ischemia, an accurate prediction of the patient’s outcome and reliable guidance in the decision-making process. Unfortunately, such a marker does not exist; in contrast, we have a number of imperfect markers that if associated can provide a reasonably good noninvasive estimation of the presence, extent, and severity of myocardial ischemia. The pathophysiological concept of the ischemic cascade is translated into a gradient of sensitivity of different available clinical markers of ischemia, with chest pain being the least sensitive and regional malperfusion the most sensitive (Fig. 3.2).

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Authors and Affiliations

  1. Medical College of Wisconsin, Milwaukee, WI, USA

    Vicente Bodì Peris PhD

  2. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA

    Eugenio Picano PhD

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  1. Vicente Bodì Peris PhD
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  2. Eugenio Picano PhD
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Correspondence to Vicente Bodì Peris PhD .

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Peris, V.B., Picano, E. (2015). Symptoms and Signs of Myocardial Ischemia. In: Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-20958-6_3

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  • DOI: https://doi.org/10.1007/978-3-319-20958-6_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20957-9

  • Online ISBN: 978-3-319-20958-6

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