Pepine C J
Department of Medicine, University of Florida, Gainesville 32610.
Circulation. 1990 Sep;82(3 Suppl):II135-42.
Silent myocardial ischemia is increasingly recognized as a common phenomenon in a variety of populations with coronary artery disease. In patients with angina pectoris, this condition has been recognized during either exercise stress testing or ambulatory monitoring when ischemic-type ST-segment shifts occur without symptoms. Although more information is clearly needed, available data suggest an important independent relation between ambulant ischemia, most of which is silent, and adverse outcome. Other studies show that currently available antianginal agents can prevent or modify symptomatic as well as silent ischemic episodes. Several reports indicate that when these agents are prescribed to control symptomatic ischemic episodes, silent ischemia may continue to occur. Yet, when antianginal drugs are used either alone or in combination in those with recurrent silent ischemia, both the frequency and duration of the silent ischemic episodes are greatly reduced. To date, however, no data are yet available on the impact on outcome of a strategy directed at detecting and treating silent ischemia. Until this information is available, more attention should be focused on identifying and adequately controlling ischemia rather than on simply managing chest pain.
无症状性心肌缺血日益被认为是各类冠心病患者中的常见现象。在心绞痛患者中，这种情况在运动负荷试验或动态监测期间被识别出来，即出现缺血型ST段移位但无相关症状。尽管显然还需要更多信息，但现有数据表明，大多数无症状的动态缺血与不良后果之间存在重要的独立关联。其他研究表明，目前可用的抗心绞痛药物可以预防或改善有症状的以及无症状的缺血发作。有几份报告指出，当使用这些药物来控制有症状的缺血发作时，无症状性缺血可能会继续发生。然而，当在复发性无症状性缺血患者中单独或联合使用抗心绞痛药物时，无症状性缺血发作的频率和持续时间都会大大降低。然而，迄今为止，尚无关于针对检测和治疗无症状性缺血的策略对预后影响的数据。在获得这些信息之前，应更多地关注识别和充分控制缺血，而不是仅仅处理胸痛。
