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Silent Ischemia

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By definition ‘Silent ischemia’ is the presence of myocardial ischemia which is not accompanied by its typical symptoms, like angina pectoris. Many people experience ischemic episodes without being aware of this fact; that is why they can suffer a Myocardial Infraction without any prior warning. Silent or atypical ischemia is especially dangerous because, by not showing any signs or symptoms it is hard to set a clear diagnostic, moreover silent ischemia is believed to be the major cause of morbidity among people suffering of diabetes.

Episodes of silent ischemia can also occur to people who practice minimal or no physicalactivity but also to individuals withstressful lifestyles.

Silent ischemia can have two manifestations –first of them being the unrecognizedinfarction or the silent myocardial infarction, and secondly the atypicalmyocardial infarction. Bought of them are especially dangerous because they can be accompanied by symptoms that both the patient and the physician can’t identify as the manifestations of myocardial infraction.

Risk factors for silent ischemia are: hypertension, previous heart attacks, surgical revascularization, old age, and, the most important diabetes although many individuals who have experienced this condition don’t have an apparent contributor.

Silent ischemia manifests itself mostly among patients suffering of diabetes because angina pectoris, commonly known as chest pain or the clinical manifestation of the shortage of the blood flow in the heart is not felt at all or it is perceived at a low level that is not considered a warning due to a condition called neuropathy, a form of nerve damage common encountered among patients suffering of diabetes. Silent ischemia is very concerning in patients with diabetes because due to not showing any warning signs patients don’t consult the doctor and moreover they cannot be evaluated, diagnosed or treated efficiently. Worldwide cardiovascular disease is the leading cause of mortality among patients suffering of diabetes.

Studies show that at least one up to fourth of patients withdiabetes who have experienced a heart attack have unrecognized silent, atypical episodes, accompanied by unrecognizable symptoms of ischemic heart disease.

In order to prevent an atypical heart attack, physicians recommend, for diabetic patients, cardiac stress testing. It is also highly recommended for those with proteinuria ormicroalbuminuria, carotid occlusivedisease, peripheral vascular disease, and for patients who have an abnormal ECG. It is indicated as well for those that are preparing for the transition, from a sedentary life-style to a series of physical exercises.

New myocardial imaging techniques, nuclear myocardial perfusion imaging or echocardiography constitute alternative methods for testing diagnosing cardiac conditions like silent ischemia in diabetics.

Regular controls of lipid and glucose levels in the blood as well as the blood pressure controls, associated with aspirin therapy are the new bookmarks in diabetes therapy.

Patients with ischemic heart disease require more attention and greateremphasis is set on the high-risk patients that experience resistance to pharmacotherapy – to the use of ACE inhibitors, ß-blockers, nitrates, ARBs and CCBs. Revascularization therapywas also proven to be effective.

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