Purcell H, Mulcahy D, Fox K
Royal Brompton Hospital, London, UK.
Cardiovasc Drugs Ther. 1994 Oct;8(5):727-34. doi: 10.1007/BF00877119.
In recent years it has become clear that episodes of transient myocardial ischemia commonly occur in patients with coronary artery disease in the absence of chest pain or angina equivalent. These episodes of "silent myocardial ischemia" are particularly well documented during continuous ambulatory electrocardiographic monitoring in daily life. Evidence suggests that these episodes represent true ischemia, and appear to be a marker of unfavorable outcome. While the pathophysiology is not completely understood, it appears as though the mechanisms of angina and silent ischemia are the same. Both forms of ischemia respond to conventional antianginal medication. While long-acting nitrates are effective in reducing or preventing myocardial ischemia, because of their propensity to cause tolerance they should be used intermittently and in association with either beta-blockers or calcium antagonists. Nitrates are safe and comparatively inexpensive, and will continue to play an important role in the treatment and prevention of angina. However, in the light of current knowledge, there is no specific indication for the treatment of silent ischemia by nitrates.
近年来，已经明确的是，短暂性心肌缺血发作在冠状动脉疾病患者中通常在无胸痛或等效性心绞痛的情况下发生。这些“无症状性心肌缺血”发作在日常生活中的动态心电图连续监测期间有特别充分的记录。有证据表明，这些发作代表真正的缺血，并且似乎是不良预后的一个标志。虽然其病理生理学尚未完全了解，但心绞痛和无症状性缺血的机制似乎是相同的。两种形式的缺血都对传统抗心绞痛药物有反应。长效硝酸盐在减少或预防心肌缺血方面有效，但由于它们容易产生耐受性，应间歇性使用，并与β受体阻滞剂或钙拮抗剂联合使用。硝酸盐安全且相对便宜，将继续在心绞痛的治疗和预防中发挥重要作用。然而，根据目前的知识，硝酸盐治疗无症状性缺血并无特定指征。
