Asymptomatic or silent myocardial ischemia in angina pectoris: pathophysiology and clinical implications.

Patients with angina pectoris often have asymptomatic myocardial ischemia, which can be detected by exercise testing, ambulatory (Holter) monitoring, and other diagnostic methods. Studies suggest that the presence of frequent and prolonged episodes of ischemia are associated with an adverse prognosis. Standard antiangina strategies have been found to be effective in reducing exercise and spontaneous episodes of ischemia. However, whether the targeted suppression of all ischemic activity should be a therapeutic goal remains unresolved and is the focus of current research efforts.