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Silent myocardial ischemia in unstable angina: Prognostic considerations

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Silent Ischemia

Abstract

Unstable angina is a high risk syndrome which may be defined by the new onset of angina symptoms, a crescendo pattern of angina, and the occurrence of rest angina. The pathophysiology of this condition is complex, and involves a combination of fixed coronary atherosclerosis and superimposed dynamic coronary obstruction, mediated by coronary vasoconstriction, and/or platelet aggregation and thrombosis (1,2). Although aggressive medical therapy for patients with unstable angina often successfully controls symptoms in the coronary care unit, a significant proportion of patients whose symptoms are initially ameliorated nevertheless experience cardiac death, myocardial infarction, and recurrent angina requiring revascularization (3–6).

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References

  1. Maseri A (1986) Pathogenetic classification of unstable angina as guideline to individual management and prognosis. Am J Med 80 (suppl 4C): 48–55

    Article  PubMed  CAS  Google Scholar 

  2. Epstein SE, Palmieri ST (1984) Mechanisms contributing to precipitation of unstable angina and acute myocardial infarction: implications regarding therapy. Am J Cardiol 54: 1245–1252

    Article  PubMed  CAS  Google Scholar 

  3. Russell RO, Moraski RE, Kouchoukos N, et al (1978) Unstable angina pectoris: National cooperative study group to compare surgical and medical therapy. II. In-hospital experience and initial follow-up results in patients with one, two and three vessel disease. Am J Cardiol 42: 839–848

    Article  Google Scholar 

  4. Gerstenblith G, Ouyang P, Achuff SC et al (1982) Nifedipine in unstable angina. A double-blind, randomized trial. N Engl J Med 306: 885–889

    Article  PubMed  CAS  Google Scholar 

  5. Muller JE, Turi ZG, Pearle DL, et al (1984) Nifedipine and conventional therapy for unstable angina pectoris: a randomized, double-blind comparison. Circulation 69: 729–739

    Google Scholar 

  6. Gottlieb SO, Weisfeldt ML, Ouyang P, et al (1986) Effect of the addition of propranolol to therapy with nifedipine for unstable angina: a randomized, double-blind, placebo-controlled trial. Circulation 73: 331–337

    Article  PubMed  CAS  Google Scholar 

  7. Stern S, Tzivoni D (1974) Early detection of silent ischemic heart disease by 24 hour electrocardiographic monitoring of active subjects. Br Heart J 36: 481–86

    Article  PubMed  CAS  Google Scholar 

  8. Schang SJ, Pepine CJ (1977) Transient asymptomatic ST segment depression during daily activity. Am J Cardiol 39: 396–400

    Article  PubMed  Google Scholar 

  9. Deanfield J, Maseri A, Selwyn A, et al (1983) Myocardial ischemia during daily life in patients with stable angina: Its relation to symptoms and heart rate changes. Lancet 1983; 753–8

    Google Scholar 

  10. Cecchi AC, Dovellini EV, Marchi F, et al (1983) Silent myocardial ischemia during ambulatory electrocardiographic monitoring in patients with effort angina. J Am Coll Cardiol 1 (3): 934–939

    Article  PubMed  CAS  Google Scholar 

  11. Biagini A, Mazzei MG, Carpeggiani C, et al (1982) Vasospastic ischemic mechanism of frequent asymptomatic transient ST-T changes during continuous electrocardiographic monitoring of selected unstable angina patients. Am Heart J 103: 13–19

    Article  PubMed  CAS  Google Scholar 

  12. Nademanee K, Intarachot V, Piontek M, et al (1984) Silent myocardial ischemia on Holier: has it clinical significance? (abstr) Circulation: 70 (suppl) II: 11–452

    Google Scholar 

  13. Johnson SM, Mauritson DR, Winniford MD, et al (1982) Continuous electrocardiographic monitoring in patients with unstable angina pectoris. Idntification of high-risk subgrop with severe coronary disease, variant angina, and/or impaired early prognosis. Am Heart J 103: 4–12

    Article  PubMed  CAS  Google Scholar 

  14. Chierchia S, Lazzari M, Freedman B, et al (1983) Impairment of myocardial perfusion and function during painless myocardial ischemia. J Am Coll Cardiol 1 (3): 924–930

    Article  PubMed  CAS  Google Scholar 

  15. Cohn PF, Brown EJ, Wynne J, et al (1983) Global and regional left ventricular ejection fraction abnormalities during exercise in patients with silent myocardial ischemia. J Am Coll Cardiol 1 (3): 931–933

    Article  PubMed  CAS  Google Scholar 

  16. Deanfield JE, Shea M., Ribiero P, et al (1984) Transient ST segment depression as a marker of myocardial ischemia during daily life. Am J Cardiol 54: 1195–1200

    Article  PubMed  CAS  Google Scholar 

  17. Hoher NJ (1961) New method for heart studies: Continuous electrocardiography of active subjects over long periods is now practical. Science 134: 1214

    Article  Google Scholar 

  18. Levy RD, Shapiro LM, Wright C, Mockus L, Quyyumi AA, Fox KM (1986) The significance of painless ST segment depression assessed by ambulatory pulmonary artery pressure monitoring. J Am Coll Cardiol 7: 192A

    Google Scholar 

  19. Deanfield J, Ribiero P, Oakley K, et al (1984) Critical analysis of ST segment changes in normal subjects: Implications for ambulatory monitoring of myocardial ischemia in patients with angina. Am J Cardiol 54: 1321–1325

    Article  PubMed  CAS  Google Scholar 

  20. Shook TL, Balke CW, Kotilainen PW, Selwyn AP, Stone PH. Accuracy of detection of myocardial ischemia by amplitude-modulated and frequency-modulated holier techniques. J Am Coll Cardiol 7: 104A (abstract)

    Google Scholar 

  21. Gottlieb SO, Weisfeldt ML, Ouyang P, Mellits ED, Gerstenblith G (1986) Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina. N Engl J Med 314: 1214–19

    Article  PubMed  CAS  Google Scholar 

  22. Ouyang P, Bulkley BH, Mellits ED, et al (1983) A double-blind, randomized trial of nifedipine in post-infarction unstable angina. Pract Cardiol 3: 30–38

    Google Scholar 

  23. Telford AM Wilson C (1981) Trial of heparin versus atenolol in prevention of myocardial infarction in intermediate coronary syndrome. Lancet I: 1225–1228

    Article  Google Scholar 

  24. Lewis HD Jr, Davis JW, Archibald DG, et al (1983) Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med 309: 396–403

    Article  PubMed  Google Scholar 

  25. Cairns JA, Gent M, Singer J, et al (1985) Aspirin, sulfinpyrazone, or both in unstable angina-results of a Canadian Multicenter Trial. N Engl J Med 313: 1369–1375

    Article  PubMed  CAS  Google Scholar 

  26. Ambrose JA, Winters SL, Stern A, et al (1985) Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 5: 609–616

    Article  PubMed  CAS  Google Scholar 

  27. Bresnahan DR, Davis JL, Holmes DR Jr, Smith HC (1985) Angiographic occurrence and clinical correlates of intraluminal coronary artery thrombus: role of unstable angina. J Am Coll Cardiol 6: 285–289

    Article  PubMed  CAS  Google Scholar 

  28. Sherman CT, Litvack F, Grundfest W, et al (1985) Fiberoptic coronary angioscopy identifies thrombus in all patients with unstable angina (abstr). Circulation 72: 111–112

    Google Scholar 

  29. Vetrovec GW, Leinbach RC, Gold HK, Cowley MJ (1982) Intracoronary thrombolysis in syndromes of unstable ischemia: angiographic and clinical results. Am Heart J 104: 946–952

    Article  PubMed  CAS  Google Scholar 

  30. Shapiro EP, Brinker JA, Gottlieb SO, Guzman PA, Bulkley BH (1985) Intracoronary thrombolysis 3 to 13 days after acute myocardial infarction for postinfarction angina pectoris. Am J Cardiol 55: 1453–1458

    Article  PubMed  CAS  Google Scholar 

  31. Seiden R, Neill WA, Ritzmann LW, Okies JE, Anderson RP (1975) Medical versus surgical therapy for acute coronary insufficiency. A randomized study. N Engl J Med 293: 1329–1333

    Article  Google Scholar 

  32. DeFeyter PJ, Serruys PW, Van Den Brand M, et al (1985) Emergency coronary angioplasty in refractory unstable angina. N Engl J Med 313: 342–346

    Article  CAS  Google Scholar 

  33. Gottlieb SO, Brin KP, Walford GD, McGaughey M, Riegel MB, Brinker JA (1986) Percutaneous transluminal coronary angioplasty for eary post-infarction unstable angina; results and follow-up. J Am Cardiol 7: 21A

    Google Scholar 

  34. Leimgruber PP, Roubin GS, Hollman J, Cotsonis GA, Meier B, Douglas JS, King SB III, Gruentzig AR (1986) Restenosis after successful coronary angioplasty in patients with single-vessel disease: Circulation 73: 710–717

    Article  PubMed  CAS  Google Scholar 

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© 1987 Springer-Verlag Berlin Heidelberg

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Gottlieb, S.O., Weisfeldt, M.L., Gerstenblith, G. (1987). Silent myocardial ischemia in unstable angina: Prognostic considerations. In: v. Arnim, T., Maseri, A. (eds) Silent Ischemia. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-662-12997-5_8

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  • DOI: https://doi.org/10.1007/978-3-662-12997-5_8

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-662-12999-9

  • Online ISBN: 978-3-662-12997-5

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