Symptoms and Signs of Myocardial Ischemia

  • Eugenio Picano


A transient regional imbalance between oxygen demand and supply usually results in myocardial ischemia, the signs and symptoms of which can be used as a diagnostic tool. Myocardial ischemia results in a typical “cascade” of events in which the various markers are hierarchically ranked in a well-defined time sequence [2]. The flow heterogeneity, especially between the subendocardial and subepicardial perfusion, is the forerunner of ischemia, followed by the metabolic changes, by the alterations in the ventricular diastolic relaxation, by the regional dyssynergy, and only at a later stage by electrocardiographic changes, global left ventricular dysfunction, and pain (Fig. 1).


Myocardial Ischemia Coronary Flow Reserve Wall Motion Abnormality Normal Coronary Artery Flow Heterogeneity 
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  1. 1.
    Donato L (1986) Concluding remarks: the “stunned” cardiologist. Can J Cardiol [Suppl A]: 26oA-262AGoogle Scholar
  2. 2.
    Heyndrickx CR, Baic H, Nelkins P, Leusen K, Fishbein MC, Vatner SF (1978) Depression of regional blood flow and wall thickening after brief coronary occlusion. Am J Physiol 234: H653 - 66oGoogle Scholar
  3. 3.
    Malliani A (1986) The elusive link between transient myocardial ischemia and pain. Circulation 73: 201 - 204PubMedCrossRefGoogle Scholar
  4. 4.
    Surawicz B (1986) ST-segment, T-wave, and U-wave changes during myocardial ischemia and after myocardial infarction. Can J Cardiol [Suppl A]: 71A - 84AGoogle Scholar
  5. 5.
    Wackers FT, Soufer R, Zaret BL (1996) Nuclear cardiology. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine, 5th edn. Saunders, Philadelphia, pp 349-369Google Scholar
  6. 6.
    Maseri A (198o) Pathogenetic mechanisms of angina pectoris: expanding views. Br Heart J 43: 648-66oGoogle Scholar
  7. 7.
    Haiat R, Desoutter P, Stoltz JP (1983) Angina pectoris without ST-T changes in patients with documented heart disease. Am Heart J 194: 883 - 884CrossRefGoogle Scholar
  8. 8.
    Maseri A, Mimmo R, Chierchia S, Marchesi C, Pesola A, L’Abbate A (1975) Coronary spasm as a cause of acute myocardial ischemia in man. Chest 68: 625-633Google Scholar
  9. 9.
    Distante A, Picano E, Moscarelli E, Palombo C, Benassi A, L’Abbate A (1985) Echocardiographic versus hemodynamic monitoring during attacks of variant angina pectoris. Am J Cardiol 55: 1316 - 1319CrossRefGoogle Scholar
  10. 10.
    Parodi O, Uthurrault N, Severi S, et al. (1981) Transient reduction of regional myocardial perfusion during angina at rest with ST segment elevation or normalization of negative T waves. Circulation 6: 1238 - 1247CrossRefGoogle Scholar
  11. 11.
    Rovai D, Distante A, Moscarelli E, Morales MA, Picano E, Palombo C, L’Abbate A (1985) Transient myocardial ischemia with minimal electrocardiographic study in patients with Prinzmetal’s angina. Am Heart J 109: 78 - 83PubMedCrossRefGoogle Scholar
  12. 12.
    Picano E, Distante A, Masini M, Moscarelli E, Lattanzi F, Lombardi M, Morales MA, L’Abbate A (1986) Echocardiographic documentation of myocardial ischemia in presence of angina pectoris. Can J Cardiol [Suppl A]: 67 A- 7o AGoogle Scholar
  13. 13.
    Picano E, Masini M, Lattanzi F, Distante A, L’Abbate A (1986) Role of dipyridamole-echocardiography test in electrocardiographically silent myocardial ischemia. Am J Cardiol 58: 235-237Google Scholar
  14. 14.
    Bolognese L, Sarasso G, Piccinnino C, Rossi L, Bongo A, Rossi P (1992) Silent versus symptomatic dipyridamole-induced ischemia after myocardial infarction: clinical and prognostic significance. J Am Coll Cardiol 19: 953 - 959Google Scholar
  15. 15.
    Cohn PF (1992) Silent left ventricular dysfunction during dipyridamole echocardiography: a new prognostic marker (editorial). J Am Coll Cardiol 5: 960 - 961CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • Eugenio Picano
    • 1
  1. 1.Institute of Clinical PhysiologyCNRPisaItaly

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