Contemporary management of silent ischemia: the role of ambulatory monitoring

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• 作者：Solomon ; Hemant ; DeBusk ; Robert F.
• 关键词：Silent ischemia ; Ambulatory electrocardiographic monitoring ; Cardiovascular risk
• 刊名：International Journal of Cardiology
• 出版年：2004
• 出版时间：September, 2004
• 年：2004
• 卷：96
• 期：3
• 页码：311-319
• 全文大小：179 K

文摘

Silent ischemia is highly prevalent among patients with ischemic heart disease and is associated with a poor prognosis in moderate/high risk outpatients who either exhibit exercise- or pharmacological-induced myocardial ischemia, or in those patients who demonstrate silent ischemia following an acute coronary syndrome. Pharmacotherapy, including β-blockers, angiotensin-converting enzyme inhibitors, statins, calcium channel antagonists and antiplatelet agents, have all demonstrated a reduction in silent ischemia and an improvement in cardiac prognosis. The management of patients with ischemic heart disease is currently based on patients' report of anginal symptoms: documentation of silent ischemia, usually using ambulatory electrocardiography, is not incorporated into the routine management of coronary artery disease. Yet studies comparing ambulatory electrocardiography with exercise testing have shown these tests to be complementary. We review the evidence concerning the prognostic value of ambulatory electrocardiography for monitoring silent ischemia and the prognostic value of attenuating silent ischemia. Mitigation of silent ischemia improves cardiac prognosis and ambulatory electrocardiographic monitoring before and after treatment of silent ischemia can play a valuable role in the management of coronary artery disease.