There is a kind of myocardial ischemia which is not painful, but its killing power is not ambiguous and can be compared with angina. If left untreated, it can lead to permanent damage to the heart muscle and even trigger dangerous situations such as heart failure and sudden acute death. So, what tests should be done to uncover it in time?
Case review
No disease, no pain, why is myocardial ischemia
“I don’t have discomfort, why do I see a doctor? It’s a waste of money!” A 63-year-old female patient was found to have an abnormal ECG on physical examination. Because she was usually physically active and did not feel any discomfort, and had previous health with no history of disease or medication, she had refused to seek medical attention.
Finally, only after strong insistence from her family, she came to the hospital for further examination.
“A few simple tests, and if we can rule out heart problems, everyone will be relieved.” The doctor reassured.
The doctor looked over this patient’s ECG and suspected that she might have a heart problem. But again, when the medical history was followed up, there was indeed no sign of any disease. To get a more accurate picture of her condition, the doctor suggested that she review her post-exercise ECG. The results suggested that the myocardial ischemia had worsened. So another appointment was made for her to have a coronary CTA and repeat blood biochemistry. The results came back – the coronary artery stenosis was nearly 50%, while the patient had significant dyslipidemia.
Ultimately, this patient was diagnosed with coronary artery disease and painless myocardial ischemia.
This insidious ischemia
is common in patients with coronary heart disease
What is painless myocardial ischemia? Painless myocardial ischemia, also known as asymptomatic myocardial ischemia or occult myocardial ischemia. It is myocardial ischemia that exists without any symptoms. In simple terms, it is a patient who is found to have myocardial ischemia after an examination, but has no associated symptoms. Currently, the main cause of asymptomatic myocardial ischemia is coronary atherosclerosis, which is common in patients with coronary heart disease.
As stated above, the pathogenesis of painless myocardial ischemia is mainly related to coronary artery lesions, which can occur in all stages of coronary heart disease. On the one hand, the lesions may be relatively mild and belong to the early stages of coronary artery disease, as in the case of the female patient mentioned in this article. On the other hand, it is possible to have severe coronary artery disease, but already have good collateral circulation.
Clinically asymptomatic myocardial ischemia is more common than symptomatic angina pectoris, especially in elderly patients, which is related to the degeneration of tissue and organ function and higher pain threshold in the elderly.
No ambiguity in killing power
Sudden death can be caused by severe pain
The seemingly painless myocardial ischemia is actually “lethal” and cannot be underestimated. Although there are no obvious symptoms or pain, the damage to the heart is not significantly different from that of angina. If not treated in time, it can lead to permanent damage to the myocardium and later manifestations such as arrhythmia, angina pectoris, heart failure and sudden acute death. Therefore, after a clear diagnosis, active treatment measures should be taken to prevent the progression of the disease and prevent the risk of accidents.
How to uncover this dark murderer? It is actually not difficult, an electrocardiogram, especially an ambulatory electrocardiogram, is the most common method to diagnose myocardial ischemia.
