What is the best way to detect silent myocardial ischemia?
The simplest, least expensive way to detect ischemia, silent or otherwise, is exercise testing with ECG monitoring. The real question needing to be asked is “What does the lack of symptoms mean in a patient who has ECG changes consistent with ischemia during exercise?” Froehlicher et al. [3] have indicated that roughly 8% of apparently healthy US men aged 35 to 55 years will develop ST segment depression during treadmill exercise. However, only about half of the 8% have proven coronary artery disease. Thus, as in other areas of medicine and cardiology, the clinician is faced with the dilemma of determining which group their patient falls into. Is this a false-positive test, or is this evidence of myocardial ischemia? As mentioned previously, some other method needs to be used to confirm that the ECG changes seen on stress testing or on the ambulatory ECG are related to myocardial ischemia.
