Lüderitz B
Department of Internal Medicine-Cardiology, University of Bonn, Federal Republic of Germany.
Eur J Clin Pharmacol. 1990;38 Suppl 1:S69-71. doi: 10.1007/BF01417568.
Silent myocardial ischemia is a serious progressive disease which deserves continuous surveillance. It is characterized by painless ST-segment depression based on coronary artery disease. The mechanisms responsible for producing this condition do not differ from stable angina pectoris. The prognostic implications of silent ischemia are not yet completely clarified. However it could be argued that patients die--whether or not angina pectoris is present--because they develop myocardial infarction or ischemic ventricular arrhythmias. Complex ventricular arrhythmias seem to occur not at a higher rate than in patients with angina pectoris. On the other hand there is no doubt about a present arrhythmogenic potential of a silent myocardial ischemia, but there is so far no clinical evidence that the prognostic significance is different to symptomatic myocardial ischemia. In order to reduce or eliminate ischemic episodes intensive combination medical therapy should be used. If symptoms recur or ischemic changes are persistent, consideration should be given to revascularisation. Nevertheless, the optimal way of treating silent ischemia is still to be defined.
无症状性心肌缺血是一种严重的进行性疾病，值得持续监测。它的特征是基于冠状动脉疾病的无痛性ST段压低。产生这种情况的机制与稳定型心绞痛并无不同。无症状性缺血的预后影响尚未完全阐明。然而，可以认为患者死亡——无论是否存在心绞痛——是因为他们发生了心肌梗死或缺血性室性心律失常。复杂室性心律失常的发生率似乎并不高于心绞痛患者。另一方面，无症状性心肌缺血目前存在致心律失常的潜在风险是毫无疑问的，但迄今为止尚无临床证据表明其预后意义与有症状性心肌缺血不同。为了减少或消除缺血发作，应采用强化联合药物治疗。如果症状复发或缺血改变持续存在，则应考虑进行血运重建。然而，治疗无症状性缺血的最佳方法仍有待确定。
