Importance of silent myocardial ischemia in therapy for unstable angina pectoris

  • W. Rafflenbeul
Conference paper


In the spectrum of acute ischemic syndromes, unstable angina pectoris is characterized by specific features in the patients history, including recent occurrence of angina at rest, or brought on by minimal exertion, as well as the deterioration of a chronic stable angina into more severe, prolonged or more frequent anginal attacks (crescendo angina). Typical electrocardiographic criteria include reversible ST-segment deviations and/or variable T-wave inversions. Cardiac enzymes are usually not elevated.


Unstable Angina Coronary Care Unit Isosorbide Dinitrate Silent Myocardial Ischemia Anginal Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ambrose JA, Winters SL, Stern A, Eng A, Teichholz LE, Corlin R, Fuster V (1985) Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 5: 609–616PubMedCrossRefGoogle Scholar
  2. 2.
    Biagini A, Mazzei MG, Carpeggiani C, Testa R, Antonelli R, Michelassi C, L’Abbate A, Maseri A (1982) Vasospastic ischemic mechanism of frequent asymptomatic transient ST-T changes during continuous electrocardiographic monitoring in selected unstable angina patients. Am Heart J 103: 13–19PubMedCrossRefGoogle Scholar
  3. 3.
    Bykerk VP, Haq A, Adelman AG (1985) Changing pattern of unstable angina, a review of 90 cases. Circulation 72 (Suppl III): III–113Google Scholar
  4. 4.
    Cannom DS, Harrison DC, Schroeder JS (1974) Hemodynamic observations in patients with unstable angina pectoris. Am J Cardiol 33: 173–178Google Scholar
  5. 5.
    Chierchia S, Lazzari M, Maseri A (1981) Hemodynamic monitoring in painless myocardial ischemia (abstr). Am J Cardiol 47: 446CrossRefGoogle Scholar
  6. 6.
    Chierchia S, Sazzari M, Freedman B, Bruneli C, Maseri A (1983) Impairment of myocardial perfusion during painless myocardial ischemia. J Am Coll Cardiol 1: 924–930PubMedCrossRefGoogle Scholar
  7. 7.
    Coccol G, Braun G, Strozzi C, Leishman B, Chu B, Rochat N (1982) Asymptomatic myocardial ischemia in patients with stable and typical angina pectoris. Clin Cardiol 5: 403–408CrossRefGoogle Scholar
  8. 8.
    Cohn PF, Brown EJ, Wynne J, Holman BL, Atkins HL (1983) Global and regional left ventricular ejection fraction abnormalities during exercise in patients with silent myocardial ischemia. J Am Coll Cardiol 1: 931–933PubMedCrossRefGoogle Scholar
  9. 9.
    Curry RC, Pepine CJ, Conti CR (1979) Ambulatory monitoring to evaluate therapy results in variant angina patients. Circulation 59/60 (Suppl II): II–190Google Scholar
  10. 10.
    Davies AB, Bala Subramanian V, Cashman PMM, Raftery EB (1983) Simultaneous recording of continuous arterial pressure heart rate, and ST segment in ambulant patients with stable angina pectoris. Br Heart J 50: 85–91PubMedCrossRefGoogle Scholar
  11. 11.
    Deanfield JKE, Maseri A, Selwyn AP, Ribesito P, Chierchia S, Krikler S (1983) Myocardial ischemia during daily life in patients with stable angina: its relation of symptoms and heart rate changes. Lancet 2: 753–758PubMedCrossRefGoogle Scholar
  12. 12.
    Deanfield J, Shea M, Wilson R, et al (1983) ST-segment change as a marker of ischemia in stable angina: a patient study using positron tomography (abstr) Circulation 68: suppl III: 22Google Scholar
  13. 13.
    Falk E (1985) Unstable angina with fatal outcome: Dynamic coronary thrombosis leading to infarction and/or sudden death. Autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 71: 699–708PubMedCrossRefGoogle Scholar
  14. 14.
    Fox KM, Jonathan A, Selwyn AP (1982) Effects of platelet inhibition on myocardial ischemia Lancet 2: 727–730Google Scholar
  15. 15.
    Fuster V, Steele PM, Chesebro JH (1985) Role of platelets and thrombosis in coronary atherosclerotic disease and sudden death. J Am Coll Cardiol 5: 175B–184BPubMedCrossRefGoogle Scholar
  16. 16.
    Gottlieb SO, Weisfeldt ML, Onyang P, Mellits ED, Gersenblith G (1986) Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina. Eng J Med 314: 1214–1219CrossRefGoogle Scholar
  17. 17.
    Gottlieb SO, Weisfeldt ML, Onyang PJ, Aschuff SC, Baughman KL, Traill TA, Brinker JA, Shapiro EP, Chandra NC, Mellits ED, Townsend SN, Gerstenblith G (1986) Effects of the addition of propranolol to therapy with nifedipine for unstable angina pectoris; a randomized, double-blind, placebo-controlled trial. Circulation 73: 331–337PubMedCrossRefGoogle Scholar
  18. 18.
    Julian DG (1985) The natural history of unstable angina. In: Hugenholtz PG, Goldman BS (eds) Unstable Angina. Schattauer, Stuttgart, pp 65–70Google Scholar
  19. 19.
    Kunkes SH, Pichard AD, Smith H, Gorlin R, Herman MV (1980) Silent ST-segment deviation and extent of coronary artery disease. Am Heart J 100: 813–816PubMedCrossRefGoogle Scholar
  20. 20.
    Levin DC, Fallon JT (1982) Significance of the angiographic morphology of localized coronary stenoses. Histopathologic correlations. Circulation 66: 316–320PubMedCrossRefGoogle Scholar
  21. 21.
    Lewin HD, Davies JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE, Schnaper HW, LeWinter MM, Linares E, Pouger JM, Sabbarwal SC, Chester E, DeMots H (1983) Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: results of a Veterans Administration Cooperative Study. N Eng J Med 309: 396–403CrossRefGoogle Scholar
  22. 22.
    Lewis HD, Davis JKW, Archibald DG et al. (1983) Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med 309: 396–403PubMedCrossRefGoogle Scholar
  23. 23.
    MacAlpin KN, Kattus AA, Alvaro AB (1973) Angina pectoris at rest with preservation of exercise capacity. Circulation 47: 946–953PubMedCrossRefGoogle Scholar
  24. 24.
    Maseri A, Mimmo R, Chierchia S, Marchkesi C, Pesola A, L’Abbate A (1975) Coronary spasm as a cause of acute myocardial ischemia in man. Chest 68: 625–633CrossRefGoogle Scholar
  25. 25.
    Maseri A, Parodi O, Severi S, Pesola A (1976) Transient transmural reduction of myocardial blood flow, demonstrated by thallium-201 scintigraphy, a cause of variant angina. Circulation 54: 280–288PubMedCrossRefGoogle Scholar
  26. 26.
    Maseri A, Severi S, De Nes M, L’Abbate A, Chierchia S, Marzili M, Ballestra AM, Parodi O, Biagini A, Distante A (1978) “Variant angina”: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Am J Cardiol 42: 1019–1025PubMedCrossRefGoogle Scholar
  27. 27.
    Moise A, Theroux P, Taeymans Y, Descoings B, Lesperance J, Waters DD, Peletier GB, Bourassa MG (1983) Unstable angina and progression of coronary atherosclerosis. N Engl J Med 309: 685–689PubMedCrossRefGoogle Scholar
  28. 28.
    Nademanee K, Intarachot V, Piontek M, Gaghaiwalla Mody F, Rieder D, Josephson MA, Singh BN (1984) Silent myocardial ischemia on Holter: has it clinical significance? (abstr) Circulation 70: suppl II: 451CrossRefGoogle Scholar
  29. 29.
    Nademanee K, Intarachot V, Singh PN, Josephson MA, Singh BN (1986) Characteristics and clinical significance of silent myocardial ischemia in unstable angina. Am J Cardiol 58, 26B–33BPubMedCrossRefGoogle Scholar
  30. 30.
    Parodi O, Maseri A, Simonetti I (1979) Management of unstable angina at rest by verapamil. A double-blind cross-over study in coronary care unit. Br Heart J 41, 167–174PubMedCrossRefGoogle Scholar
  31. 31.
    Parodi O, Uthurralt N, Severi S, Bencivelli W, Michelasi C, L’Abbate A, Maseri A (1981) Transient reduction of regional myocardial perfusion during angina at rest with ST-segment depression or normalization of negative T-waves. Circulation 63: 1238–1247PubMedCrossRefGoogle Scholar
  32. 32.
    Quyyumi AA, Mockus I, Wright C, Fox KM (1985) Morphology of ambulatory ST segment changes in patients with varying severity of coronary artery disease. Investigations of the frequency of nocturnal ischemia and coronary spasm. Br Heart J 50: 186–193CrossRefGoogle Scholar
  33. 33.
    Rafflenbeul W, Smith LR, Rogers WJ, Mantle JA, Rackley CE, Russell RO (1979) Quantitative coronary arteriography. Coronary anatomy of patients with unstable angina pectoris reexamined 1 year after optimal medical therapy. Am J Cardiol 43: 699–707PubMedCrossRefGoogle Scholar
  34. 34.
    Rafflenbeul W, Urthaler F, Russell RO, Lichtlen P, James TN (1980) Dilatation of coronary artery stenoses after isosorbide dinitrate in man. Br Heart J 43, 546–549PubMedCrossRefGoogle Scholar
  35. 35.
    Rafflenbeul W, Russell RO, Lichtlen PR (1981) Angiographic anatomy of coronary arteries in unstable angina pectoris. In: Rafflenbeul W, Lichtlen P, Balcon R (eds) Unstable Angina pectoris. Stuttgart, Thieme, pp 51–57Google Scholar
  36. 36.
    Rafflenbeul W, Lichtlen PR (1982) Zum Konzept der dynamischen Koronarstenose. Z Kardiol 71:439–444PubMedGoogle Scholar
  37. 37.
    Rafflenbeul W, Lichtlen PR (1983) Release of residual vascular tone in coronary artery stenoses with Nifedipine and nitroglycerin. In: Kaltenbach M, Neufeld HN (eds). V Adalat Symposium, Excerpta Medica, Amsterdam, pp 300–308Google Scholar
  38. 38.
    Rafflenbeul W (1983) Dilation of coronary artery stenoses with diltiazem i.v. In: Fleckenstein H, Hashimoto K, Herrmann M, Schwarz H, Seipel L (eds) New Calcium Antagonists, Stuttgart, Gustav Fischer, pp 181–182Google Scholar
  39. 39.
    Rafflenbeul W, Lichtlen PR (1983) Quantitative coronary angiography: evidence of a sustained increase in vascular smooth muscle tone in coronary artery stenoses. Z Kardiol 72 (Suppl 3), pp 87–91PubMedGoogle Scholar
  40. 40.
    Rafflenbeul W, Bossaller C, Lichtlen PR (1985) Intravenous infusion in Nifedipine in patients with unstable angina pectoris. In: PR Lichtlen (ed), Recent aspects in calcium-antagonism, Schattauer, Stuttgart, pp 129–136Google Scholar
  41. 41.
    Sherman CT, Litvack F, Grundfest W et al. (1986) Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 315: 913–919PubMedCrossRefGoogle Scholar
  42. 42.
    Telford AM, Wilson C (1985) Trial of heparin versus atenolol in prevention of myocardial infarction in intermediate coronary syndrome. Lancet 1, 1225–1231Google Scholar
  43. 43.
    Winniford MD, Gabliani G, Johnson SM, Mauritson DR, Fulton KL, Hillis LD (1984) Concomitant calcium antagonist plus isosorbide dinitrate therapy for markedly active variant angina. Am Heart J 108, 1269–1273PubMedCrossRefGoogle Scholar
  44. 44.
    Yasue H, Omoe S, Takizawa A, Nagao M, Hyon H, Nishida S, Horie M (1981) Comparison of coronary arteriographic findings during angina pectoris associated with ST segment elevation or depression. Am J Cardiol 47: 539–546PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • W. Rafflenbeul
    • 1
    • 2
  1. 1.Division of CardiologyHannover Medical SchoolGermany
  2. 2.Division of CardiologyHannover Medical SchoolHannover 61Germany

Personalised recommendations