Silent Ischemia - Myocardial Ischemia Without Angina

What is silent ischemia?

The medical definition of silent myocardial ischemia is verified myocardial ischemia without angina. Ischemia is a reduction of oxygen-rich blood supply to the heart muscle. Silent ischemia occurs when the heart temporarily doesn’t receive enough blood (and thus oxygen), but the person with the oxygen-deprivation doesn’t notice any effects. Silent ischemia is related to angina, which is a reduction of oxygen-rich blood in the heart that causes chest pain and other related symptoms.

When is silent ischemia likely to happen?

Most silent ischemia occurs when one or more coronary arteries are narrowed by plaque. It can also occur when the heart is forced to work harder than normal.

People who have diabetes or who have had a heart attack are most likely to develop silent ischemia.

How do you know if it’s happening?

The only way to know for sure if silent ischemia is happening is to have diagnostic tests. Many people who have angina also have episodes of silent ischemia, so if you experience angina, there’s a good chance you’re having silent ischemic episodes as well.

How is silent ischemia diagnosed?

Silent ischemia is usually not discovered until someone undergoes a stress test for another reason, like angina or cardiovascular disease risk. An electrocardiogram may also find evidence of ischemia. A Holter monitor is a long-term electrocardiogram. You wear a heart monitor for one or two days, and your heart rate and rhythm are monitored the whole time. If you have an episode of ischemia during that time and you didn’t experience any symptoms during the episode, your doctor may diagnose silent ischemia.

Who is most at risk for silent ischemia?

People who are at risk for heart disease and angina are also at risk for silent ischemia. Risk factors include:

  • Tobacco use
  • Diabetes
  • High blood cholesterol
  • High blood pressure
  • A family history of heart disease
  • Age (after age 45 for men and age 55 for women, risk increases)
  • A sedentary lifestyle
  • Obesity
  • Unmanaged stress

How can I reduce my risk?

To reduce your risk for silent ischemia, you should reduce your risk for heart disease in general. Here are some things you can do:

  • Stop using tobacco of all kinds – including chewing and smoking tobacco and inhaling significant secondhand smoke
  • Prevent diabetes or manage it if you have it
  • Prevent or manage high blood pressure
  • Prevent or treat high blood cholesterol and triglyceride levels
  • Exercise regularly (talk to your doctor about what type of exercise is right for you)
  • If you’re overweight, lose weight; maintain a healthy weight
  • Eat a heart-healthy diet
  • Take steps to reduce stress in your life, and learn how to manage stress
  • See your doctor regularly, have recommended heart screenings, and follow your doctor’s instructions

What are the common treatments for silent ischemia?

If you are diagnosed with silent ischemia, your treatment plan will be developed based on several factors, including your age and overall health, your lifestyle, and your risk factors. Treatment options may include:

  • Making lifestyle changes to decrease your risk of heart attack
  • Taking medications
    • Beta blockers
    • Calcium channel blockers
    • Nitrates
    • Ranolazine
  • Oxygen treatment
  • Having a surgical procedure, such as:

What type of doctors may help treat ischemia?

Silent ischemia may be treated by internal medicine doctors; however, most doctors will refer their patients to a cardiologist, heart surgeon, cardiovascular surgeon, or cardiothoracic surgeon for diagnosis and treatment of silent ischemia and the underlying cause. Other doctors may also be part of a multidisciplinary team of experts to treat your heart disease.

Find a Beaumont cardiologist near you today, or call 800-633-737 for a referral.

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