International Medical Journal, Vol. 22., Iss. 1, 2016, P. 11−16.
SILENT MYOCARDIUM ISCHEMIA: CONTEMPORARY VIEW ON THE PROBLEM
Penza State University, Russian Federation
N. N. Burdenko Penza Region Clinical Hospital, Russian Federation
This review presents the updated understanding of the pathophysiology of silent myocardial ischemia, modern methods of its diagnosis, prognosis both in patients with stable angina and with exacerbations of coronary artery disease. Silent myocardial ischemia may be due to a defect in perception and transmission of the pain impulse (nociceptive system), increase in antinociceptive system activity, or both mechanisms simultaneously. The disease may also be caused by suppression or impaired perception of pain impulses at the thalamus level. The questions of diagnosis, clinical and prognostic significance of silent myocardial ischemia in selected groups of patients (patients with diabetes, those with the history myocardial infarction, left ventricular hypertrophy, syringomyelia, and patients taking certain medications such as cytotoxic agents, antiviral, antibacterial, in which this pathological condition develops due to autonomic neuropathy and blocked stimuli transmission at nerve fibers). Particular attention is paid to this issue in acute coronary syndrome, its possible causes and modern detection methods (intracardiac monitoring, spiral computed tomography, myocardial scan) are discussed. However, in the majority of health facilities the most common method of diagnosis of transient ischemia is various modifications of monitoring ECG and stress tests. The need for 12−lead ECG telemonitoring in the intensive care unit in patients with acute coronary syndrome for the surgical correction of the tactics of their management and treatment is emphasized.
Key words: silent myocardial ischemia, acute coronary syndrome, ECG telemetry.