Bounhoure J P
Ann Cardiol Angeiol (Paris). 1986 Dec;35(10):617-22.
Silent myocardial ischemia seems a relatively frequent manifestation of coronary insufficiency. The practice of more and more sophisticated tests to detect myocardial ischemia shows that it is a relatively frequent pathological occurrence. It occurs in patients with an abnormality or a transient or constant failure of the alarm system, represented by pain during the ischemia. It is an heterogenous picture which may take the appearance of a completely silent ischemia (the metabolic, hemodynamic and electrical consequences of ischemia being the only symptoms of coronary insufficiency, demonstrated by the presence of severe, angiographic or anatomical, stenoses); of a silent transient ischemia (with alternance of symptomatic and silent episodes or with silent episodes after myocardial infarction); of myocardial necroses without pain or ischemic myocardiopathies. It is the consequences of either an ischemia which is too moderate to reach the pain threshold, or a severe ischemia in patients presenting alterations of the transmission system and of the perception of pain. It has metabolic, hemodynamic and anatomical consequences which may lead to necrosis or degeneration and fibrosis of the myocardium. The prognosis of a painless disease is difficult to make but it does not seem to be as poor as the one of the usual forms of ischemic cardiopathies. Medical treatment is mandatory, and surveillance of its efficacy must be systematic using the techniques of detection of the ischemia.
无症状性心肌缺血似乎是冠状动脉供血不足相对常见的一种表现。越来越多用于检测心肌缺血的精密检查表明，这是一种相对常见的病理现象。它发生在警报系统出现异常、短暂或持续失灵的患者身上，警报系统以缺血时的疼痛为代表。这是一种异质性情况，可能表现为完全无症状性缺血（缺血的代谢、血流动力学和电方面后果是冠状动脉供血不足的唯一症状，通过严重的血管造影或解剖学狭窄得以证实）；无症状性短暂缺血（症状性发作和无症状发作交替出现，或心肌梗死后有无症状发作）；无痛性心肌坏死或缺血性心肌病。这要么是由于缺血程度较轻未达到疼痛阈值，要么是在疼痛传导系统和痛觉感知出现改变的患者中发生严重缺血所致。它会产生代谢、血流动力学和解剖学后果，可能导致心肌坏死、变性和纤维化。无痛性疾病的预后难以判断，但似乎不像常见形式的缺血性心脏病那么差。必须进行药物治疗，并且必须使用缺血检测技术系统地监测其疗效。
