Main description:

"Silent Ischemia, Current Concepts and Management" contains the proceedings of a conference held in Rottach-Egern, West Germany, March 5 to 7, 1987. We are most grateful to the authors for the effort to provide manuscripts before the meeting, to the sponsor, Bayer AG, for their generous support and to the publishers for their efficient collaboration, all of which have made the appearance of this book possible. When discussing silent myocardial ischemia, the first question is: "why is it silent?". To approach this question, a deeper look has to be taken into the pathophysiology of cardiac pain and the excitatory and inhibitory mechanisms involved. It has to be borne in mind that - in contradiction to what the poets have told us so beautifully for many centuries - the heart is a visceral and not a sensitive organ. If asymptomatic ischemia did not carry prognostic significance comparable to the symp tomatic manifestations of ischemia, then the problem of silent ischemia would be very academic and without consequences for treatment. Therefore studies on prognosis of silent ischemia are of great importance, as their results should indicate how aggressively patients are to be managed.

Contents:

Central mechanisms of pain control: a survey.- Peripheral innervation of the heart.- Pathophysiology of ischemic cardiac pain.- Alpha-receptors and transient ischemia.- Experimental approach to painful and painless ischemia.- Silent myocardial ischemia in middle aged men: Long term clinical course.- Prognostic implications of silent ischemia in patients with stable angina pectoris.- Silent myocardial ischemia in unstable angina: Prognostic considerations.- Prevalence of ventricular arrhythmias during silent myocardial ischemia.- Arrhythmogenic potential of silent myocardial ischemia after myocardial infarction.- Prevalence of silent ischemia in patients undergoing coronary angiography.- Identification of patients with silent myocardial ischemia by metabolic, scintigraphic and angiographic findings.- The frequency, pathophysiology, and prognosis of exercise-induced silent ischemia.- Regional wall motion disorders during exercise with and without angina.- Non invasive detection of silent myocardial ischemia with echocardiography.- Symptomatic versus asymptomatic ischemic episodes during Holter monitoring: patterns of high resolution trend recordings of ST segment and heart rate.- Silent ischemia and coronary anatomy.- Dedicated ST-segment monitoring in the CCU after successful coronary angioplasty: incidence and prognosis of silent and symptomatic ischemia.- Hemodynamics of painless ischemia.- Medical and surgical therapy of patients with asymptomatic ischemia.- Coronary angioplasty in silent myocardial ischemia.- Alleviation of silent ischemia by PTCA.- Guiding anti-ischemic therapy by Holter monitoring.- Silent myocardial ischemia: Current concepts and management.- Importance of silent myocardial ischemia in therapy for unstable angina pectoris.- Variability of myocardial ischemia in chronic stable angina.- Clinical significance of silent myocardial ischemia.