Silent Myocardial Ischemia

Gutterman, David D.

doi:10.1253/circj.cj-08-1209

Cited by 70 publications

(66 citation statements)

References 114 publications

(121 reference statements)

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“…Several factors have been related to the absence of symptoms during myocardial ischemia, but the precise mechanisms responsible for the lack of pain have not yet been fully elucidated [1,7,8,9]. Several studies have shown that in patients with SMI, the threshold of pain perception and tolerance are significantly higher than in symptomatic patients [8,27].…”

Section: Discussionmentioning

confidence: 99%

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Primary Headache and Silent Myocardial Ischemia in Patients with Coronary Artery Disease

et al. 2013

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Objective: The mechanisms by which migraine is linked to ischemic vascular disease remain uncertain and are likely to be complex. The aim of this study was to investigate the correlation between silent myocardial ischemia (SMI) and a history of documented primary headache in a large population of patients with exercise-induced myocardial ischemia. Methods: The study involved 1,427 consecutive patients (918 symptomatic and 509 asymptomatic patients) with exercise-induced myocardial ischemia and documented coronary artery disease (CAD). Results: Patients with anginal symptoms during exercise-induced myocardial ischemia had a significantly higher prevalence of primary headache than those without (41 vs. 30%, p < 0.001). Patients with angina pectoris in daily life also had greater prevalence of primary headache than those without anginal symptoms (37 vs. 20%; p < 0.0001). Symptomatic patients during percutaneous transluminal coronary angiography or myocardial infarction had a greater prevalence of primary headache than asymptomatic patients (p < 0.001 and p = 0.005, respectively). Conclusions: Our data suggest that a history of headache in CAD population is correlated to a high probability of anginal symptoms and a decreased probability of SMI. The anamnestic absence of headache requires a close monitoring for patients with risk factors for CAD, because this population seems to have a lower susceptibility to pain and the risk of developing SMI might be increased.

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Section: Discussionmentioning

confidence: 99%

“…Silent myocardial ischemia (SMI) is defined as an objective documentation of myocardial ischemia in the absence of angina or anginal equivalents [1]. …”

Section: Introductionmentioning

confidence: 99%

Primary Headache and Silent Myocardial Ischemia in Patients with Coronary Artery Disease

et al. 2013

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“…By definition, any symptoms of cardiac ischemia must be absent in order to make the diagnosis of silent ischemia [6]. However, elderly people without a history of cerebral infarction often present with atypical symptoms of myocardial infarction, i.e.…”

Section: Discussionmentioning

confidence: 99%

Silent Cardiac Ischemia after an Ischemic Stroke of the Right Hemisphere

Kasius

Lamfers²,

Venderink

et al. 2011

Cardiology

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A patient is described who previously had daily complaints of angina pectoris, yet no longer experienced chest pain after an ischemic stroke of the right hemisphere, despite several recorded episodes of electrocardiographic changes and an elevation of cardiac enzymes compatible with myocardial ischemia. The cingulate gyrus is involved in spatial attention and neglect, and is, according to positron emission tomography studies, less activated in silent myocardial ischemia. We suggest that this patient was not aware of the angina because of putamen ischemia and secondary disturbed projection to the cingulate gyrus and no longer felt or experienced this referred pain.

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“…Furthermore, cerebral responses have been shown to be different between patients with angina and those with silent myocardial ischemia during systemic dobutamine infusion (Rosen et al 1996), although silent myocardial ischemia may be associated with both functional and organic abnormalities (Canto et al 2000;Gutterman 2009). Therefore, CEPs in response to selective electrical stimulation of the heart could be useful for examining the pathophysiology of cardiac anxiety and/or silent myocardial ischemia.…”

Section: Possible Application Of Ceps In Response To Cardiac Electricmentioning

confidence: 99%

“…In general, females and patients with psychiatric disorders are more prone to palpitation and/or chest pain without organic heart disease (cardiac anxiety) (Serlie et al 1995;Barsky et al 1996;Ehlers et al 2000;Barsky 2001). In contrast, arrhythmias are often asymptomatic (Barsky 2001), and painless cardiac ischemic events (silent myocardial ischemia), which are associated with poor prognosis (Canto et al 2000;Gutterman 2009), are common. Therefore, it is clinically important to elucidate the mechanisms of cardiac sensation in order to improve the quality of life of patients with complaining of cardiac sensation, as well as to improve the prognosis of cardiovascular disease.…”

mentioning

confidence: 99%

Brain Responses to Cardiac Electrical Stimulation: A New EEG Method for Evaluating Cardiac Sensation

Suzuki

Hirose

Watanabe

et al. 2012

Tohoku J. Exp. Med.

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Although cardiac sensation, such as palpitation or chest pain, is common and is sometimes a malignant sign of heart diseases, the mechanism by which the human brain responds to afferent signals from the heart remains unclear. In this study, we investigated whether electrical stimulation of the heart provokes brain responses in humans. We examined 15 patients (age: 65.4 ± 3.1 years old, 11 males and 4 females) implanted with either a cardiac pacemaker or cardiac resynchronization therapy (CRT) device. Electroencephalogram (EEG) was simultaneously recorded from the vertex during right ventricular pacing at 70-100 beats/min at baseline (1.5 V) and intense (6-8 V) stimulation sessions. We evaluated brain responses to cardiac electrical stimulation by measuring cerebral potentials that were obtained by subtracting the average of 100 EEG waves triggered by cardiac pacing during baseline stimulation from those during the intense stimulation. Intense stimulation of the cardiac pacemaker or CRT device reproducibly induced cardiac sensation in 6 out of the 15 patients; namely, the remaining 9 patients showed no reproducible response. Brain responses were evident by averaging cerebral potentials from all of the 15 patients and those from 6 patients with reproducible cardiac sensation. To the best our knowledge, this is the first report that demonstrates the brain responses to cardiac electrical stimulation in humans. This new method should be useful for examining pathophysiology of cardiac diseases with pathological cardiac sensation, including cardiac anxiety and silent myocardial ischemia.

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Silent Myocardial Ischemia

Cited by 70 publications

References 114 publications

Primary Headache and Silent Myocardial Ischemia in Patients with Coronary Artery Disease

Primary Headache and Silent Myocardial Ischemia in Patients with Coronary Artery Disease

Silent Cardiac Ischemia after an Ischemic Stroke of the Right Hemisphere

Brain Responses to Cardiac Electrical Stimulation: A New EEG Method for Evaluating Cardiac Sensation

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