Silent Myocardial Ischemia

Cohn, Peter F.; Fox, Kim; Daly, Caroline

doi:10.1161/01.cir.0000088001.59265.ee

Cited by 257 publications

(151 citation statements)

References 133 publications

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“…5,6) In addition, the pain severity does not seem to be a good predictor of the outcome of myocardial infarction. 7) While the evaluation of pain in humans is predominantly based on conscious perception, in animals it relies mainly on behavioral output. 8) Defined by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience, 9) pain cannot be determined in animals, so proxy indicators are typically used.…”

Section: )mentioning

confidence: 99%

Behavioral Changes Following Experimentally-Induced Acute Myocardial Infarction in Rats

et al. 2014

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SummaryRats with experimentally-induced acute myocardial infarction (AMI) have proven to be a clinically relevant model for visceral pain. As there are no behavioral data available on rats in the postinfarction period, we aimed to identify specifi c pain-related behavioral changes following AMI to increase the validity of the model. AMI was induced by left coronary artery ligation and pain-related behavior was analyzed using the open fi eld test (OFT) and elevated plus maze (EPM). Morphine was applied following AMI induction to differentiate pain-related changes from those related to nonspecifi c global changes in responsiveness. AMI was histologically confi rmed.Hypolocomotion was consistently evident in all behavioral tests for both the infarcted group and sham group. In the OFT, both AMI and sham rats exhibited less exploratory behavior and less activity. A similar pattern of behavior was observed in EPM, where both surgical groups showed fewer entries to the open arms and spent less time in the open arms. The sham group with an intact pericardium showed the same pattern of activity as control rats. The reduction in activity and rearing observed following AMI was successfully reversed following morphine injection. This effect was abolished after naloxone application allowing us to attribute observed changes specifi cally to pain.This study demonstrates that pain-related behavior in the acute postinfarction period is generally characterized by reduced mobility and explorative behavior. Our results showed that cardiac ischemia as a consequence of experimentally-induced infarction is a less important source of pain behavior than manipulation of the pericardium. (Int Heart J 2014; 55: 169-177) Key words: Pericardium, Postoperative pain, Behavior C hest pain is the primary and the most prominent symptom leading to the hospitalization of patients with the diagnosis of acute myocardial infarction (AMI). 1)These patients account for 20% of patients in medical emergency departments.2) However, chest pain related to AMI varies signifi cantly both in its intensity 3,4) and incidence. 5,6) In addition, the pain severity does not seem to be a good predictor of the outcome of myocardial infarction. 7)While the evaluation of pain in humans is predominantly based on conscious perception, in animals it relies mainly on behavioral output. 8) Defined by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience, 9) pain cannot be determined in animals, so proxy indicators are typically used. In order to increase the translational value of their studies, pain researchers working with experimental animals have focused more on complex behavioral responses and operant measures.10,11) Visceral pain models, eg, models of cardiac ischemia, delineate well these challenges. Pain elicited in these models is vague, with no specifi c region to focus pain measurements on, so broader behavioral and cognitive analysis is necessary to detect potential changes.12)The most commonly used stimuli i...

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Section: )mentioning

confidence: 99%

Behavioral Changes Following Experimentally-Induced Acute Myocardial Infarction in Rats

et al. 2014

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“…1,2 Even very serious and severe episodes of ischaemia may be asymptomatic, with an estimated 10-15% of myocardial infarctions being silent. 3 Further, approximately 50% of cardiac patients who report angina pectoris have episodes of silent ischaemia, 2 and even 25-33% of patients who are considered to be adequately treated continue to have silent ischaemia. 4 However, very little is known about the underlying mechanisms of silent ischaemia.…”

Section: Introductionmentioning

confidence: 99%

“…3 Further, approximately 50% of cardiac patients who report angina pectoris have episodes of silent ischaemia, 2 and even 25-33% of patients who are considered to be adequately treated continue to have silent ischaemia. 4 However, very little is known about the underlying mechanisms of silent ischaemia. One potential pathway that may contribute to this absence of pain is increased blood pressure.…”

Section: Introductionmentioning

confidence: 99%

The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease

et al. 2006

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Silent myocardial ischaemia is a common phenomenon in patients with coronary heart disease. However, very little is known about the underlying mechanisms of silent ischaemia. One potential pathway that may contribute to this absence of pain is increased blood pressure. The main aim of the current study was to assess the associations among blood pressure, pain and ischaemia in patients undergoing a standard exercise stress test. We hypothesized that patients who experienced chest pain during exercise would have lower baseline and peak blood pressures compared to those who did not experience chest pain. A total of 1355 patients (418 women) who underwent a single-photon emission computed tomography treadmill exercise stress test and had not experienced a cardiac event in the past 2 weeks participated in the current study. Myocardial perfusion defects were assessed at rest and during the stress challenge. Systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR) and rate pressure product (RPP) were assessed during rest and at peak exercise. There were no main effects of either pain or ischaemia on the baseline cardiovascular variables. Peak exercise data revealed main effects of pain on SBP, RPP and HR, and main effects of ischaemia on SBP and RPP, controlling for age, sex, baseline level, medication status and cardiac history. These findings suggest that acute rather than chronic increases in blood pressure may be one mechanism to explain the phenomena of silent myocardial ischaemia in cardiac patients, and may potentially provide a target for future treatment strategies.

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“…Most of the heart events are preceded or accompanied by myocardial ischemia (MI). Since the 1970s, a so-called silent myocardial ischemia (SMI) was described, which was defined as an objective documentation of MI in the absence of angina or anginal equivalents (1). According to stress test and Holter monitoring data, it was estimated that the frequency of SMI varied from 30 to 43% annually (1).…”

Section: Introductionmentioning

confidence: 99%

“…Since the 1970s, a so-called silent myocardial ischemia (SMI) was described, which was defined as an objective documentation of MI in the absence of angina or anginal equivalents (1). According to stress test and Holter monitoring data, it was estimated that the frequency of SMI varied from 30 to 43% annually (1). Some individuals, such as those with diabetes, are prone to suffer from SMI (2).…”

Section: Introductionmentioning

confidence: 99%

Silent myocardial ischemia is associated with altered plasma phospholipids

Lin

Zhang

Gao

2009

Clinical Laboratory Analysis

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Timely and accurate confirmation of the occurrence of silent myocardial ischemia (SMI) is critical both for prevention and therapy management. Metabolomics assay may offer an alternative for SMI differentiation and altered biomolecule discovery in addition to traditional measures. In this study, plasma samples were obtained from 14 diagnosed SMI subjects and 25 healthy controls and analyzed by liquid chromatography coupled with quadrupole-timeof-flight mass spectrometry in view of metabolomics. Obtained data were subjected to orthogonal signal correction partial least-squares discriminate analysis. Multivariate statistic analysis indicated a clear separation between the two studied groups. Plasma concentration fluctuation of four kinds of phospholipids showed tight relationship with the occurrence of SMI, among which 1-linoleoylglycerophosphocholine (C18:2) was decreased statistically in SMI population (P 5 0.01). The plasma phospholipids' changes were before enzymatic alteration in SMI, which might be a useful complementary reference to facilitate SMI diagnosis.

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Silent Myocardial Ischemia

Cited by 257 publications

References 133 publications

Behavioral Changes Following Experimentally-Induced Acute Myocardial Infarction in Rats

Behavioral Changes Following Experimentally-Induced Acute Myocardial Infarction in Rats

The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease

Silent myocardial ischemia is associated with altered plasma phospholipids

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