Silent Myocardial Ischemia – Causes, Symptoms & Treatment

Silent myocardial ischemia

Silent myocardial ischemia is a latent, i.e. insidious, heart disease. Drug treatment initiated at an early stage makes it possible to influence the disease to such an extent that a good quality of life can be assumed. In the advanced stage, an operation should be considered. A lifestyle with plenty of exercise, healthy food and no stimulants can prevent this.

What is silent myocardial ischemia?

In connection with coronary heart disease (CHD), silent myocardial ischemia , also known under the synonym asymptomatic myocardial ischemia , is referred to as a clinically detectable underperfusion of the heart muscle that does not cause any anginal symptoms. Angina pectoris (AP), also known as chest tightness or stenocardia, is meant by anginal symptoms . The term ischemia stands for lack of oxygen.

From a purely prognostic point of view, the course of silent myocardial ischemia is less favorable than that of symptomatic ischemia. In addition, its course is latent. This means that even with a circulatory disorder , the patient does not notice the initial course because it is taking place in secret. It is assumed that this is related to an extremely high pain threshold of the affected patients. Thus, the pathological finding initially eludes any perception and diagnostic possibility.


Silent myocardial ischemia is most common in diabetics and the elderly. Disorders of the cardiac nociceptors and the transmission of pain or the central pain receptors are mentioned as possible causes. However, it is assumed in medical circles that two to three percent of men who appear healthy are also affected.

How the exact pathological processes are presented has not been finally clarified to this day. However, a connection with diabetic neuropathy is not excluded in professional circles. Lack of oxygen is also mentioned as the cause. This can be caused in the heart muscle by stenoses (vascular narrowing), reduced oxygen saturation and reduced oxygen capacity of the blood and an effective perfusion pressure (flow pressure) in the coronary arteries.

Other causes include arterial hypertension (high blood pressure), various lipid metabolism disorders , adiposity (obesity) and various stress factors . Renal insufficiency , genetic conditions, the widespread lack of exercise or smoking can also promote silent myocardial ischemia. The more factors apply, the higher the risk of developing the disease.

Symptoms, Ailments & Signs

The pathological finding initially eludes any perception and diagnostic possibility by the doctor and patient. This form of coronary heart disease only becomes noticeable when a myocardial infarction (heart muscle infarction) or, in the worst case, sudden cardiac death, occurs. As a result, treatment by the cardiologist is often started too late. However, the effects in the ECG are very easily detectable.

Diagnosis & disease progression

The onset of silent myocardial ischemia is difficult to diagnose because there are initially no symptoms. Based on a hemodynamically relevant coronary stenosis, a reduced perfusion of the myocardium can be observed. This results in metabolic changes that lead to a change in diastolic and systolic function. Changes in the ECG and symptoms similar to those of angina pectoris can occur.


In the worst case, this disease can lead to the death of the person affected. With the help of early detection and treatment of the disease, however, this case can be avoided relatively well. Those affected can suffer an infarction of the heart muscle, which can lead to sudden cardiac death. As a rule, there is no special advance warning and no characteristic symptoms that indicate this infarction.

Those affected immediately lose consciousness and can injure themselves if they fall. If an emergency doctor does not arrive within a short time, the patient dies in most cases. Serious symptoms can also occur during treatment, so that organs or the brain are permanently damaged as a result of the infarction. As a result, many patients suffer from paralysis or other limitations in everyday life.

Medication can be taken to prevent the disease. Usually there are no special complications. After the heart attack, various therapies are necessary to treat disabilities or paralysis. As a rule, the life expectancy of those affected is reduced due to illness.

When should you go to the doctor?

Patients with this disease require medical treatment. As a rule, this disease cannot be healed on its own, so that the person affected is always dependent on an examination and treatment by a doctor. A doctor should be consulted if there are heart problems. In many cases, the disease is unfortunately only recognized very late, when a heart attack or even cardiac death has already occurred. Therefore, a doctor should always be consulted for heart problems.

This can lead to permanent tiredness, chest pains or severe heart palpitations. If such symptoms occur, an examination by a doctor should be carried out. As a rule, this disease can be detected by a cardiologist . However, further treatment depends very much on the stage of the disease, so that a complete cure is not always possible. In an emergency, an ambulance should always be called.

Treatment & Therapy

Drug treatment includes administration of anticoagulants to prevent platelet deposition and thrombus formation . Calcium channel blockers, or ACE inhibitors , are important in widening the coronary arteries and lowering blood pressure.

Nitrates, for example, perform this function. Beta-receptor blockers also lower blood pressure. At the same time, they slow down blood pressure. Statins, for example as cholesterol-lowering drugs, are also part of the drug treatment.

To begin with, an ECG (resting ECG, long-term and/or stress ECG) sitting or lying on the bicycle ergometer is required to make an initial diagnosis. Stress echocardiography can also show indications of coronary heart disease and non-functional parts of the heart muscle. The possibilities of nuclear medicine are also effective in obtaining important information.

This includes the heart catheter examination with a detailed representation of the coronary arteries ( coronary angiography ). This is an X-ray contrast display of the interior of the heart and the large vascular trunks as well as the coronary arteries. To do this, a thin catheter is advanced into the heart via a blood vessel starting from the inguinal or arm artery.

The contrast agent required for the examination or medication to dissolve blood clots is injected through this. Pressure and oxygen saturation sensors can also be inserted into the ventricles and large vessels in this way. In order to expand existing bottlenecks (dilation, PTCA), special catheters can be inserted, which in some cases even makes it possible to avoid operations on the coronary arteries.

On the other hand, blood samples can be taken for blood gas analysis . This examination is necessary in order to assess the degree of severity and to be able to determine an optimal therapy. If the diagnosis is still unclear, greater clarity can be achieved with an intraversal ultrasound (IVUS) and a determination of the coronary flow reserve.

The perfusion pressure is then measured by subtracting the diastolic ventricular pressure from the aortic pressure. Myocardial perfusion scintigraphy, stress echocardiography, but also magnetic resonance therapy and positron emission therapy and radionuclide ventriculography are available for extensive treatment to obtain a definitive diagnosis.

With all these highly technical possibilities, one must not neglect to question the family burden, including any risk factors. In addition, the new marker (osteoprotegerin) identified by the French could make it easier to diagnose silent myocardial ischemia in diabetics. An increased value should indicate the disease.


To keep the heart healthy, several factors must be considered. The diet should be low in cholesterol and sugar. But rich in vitamins , minerals , trace elements and roughage . When choosing fats, you should pay attention to unsaturated fatty acids. Native oils such as olive oil , linseed oil and coconut oil are very good .

It is also important to drink enough water every day. 1.5 to 2 liters of water, herbal teas or unsweetened juices should be drunk. Daily exercise in the fresh air is also important. A brisk walk for an hour is a good start.

Sporting activities such as swimming, jogging, endurance training and cycling provide the body with more oxygen. Smokers should consider quitting this health risk. If there is a family history, an annual check-up should also be carried out by a cardiologist.


Silent myocardial ischemia is a slowly progressive disease. With early treatment, the patient has good prospects of living a largely symptom-free life. In many cases, the diagnosis is made late because the symptoms are not apparent and the person concerned feels healthy. Another treatment option is surgery.

Follow-up care depends on the time of diagnosis and the type of therapy. Silent myocardial ischemia can take a life-threatening, unpredictable course. In the event of sudden fainting, the patient must be treated immediately by an emergency doctor. Timely action favors the outcome.

If the diagnosis is made in good time, follow-up care is aimed at maintaining quality of life. The aim is to contain the disease and alleviate the symptoms. For this, the patient is prescribed blood-thinning medication. The cardiologist controls the healing success. Follow-up care continues beyond treatment.

The condition of the person concerned should also be stabilized in the long term. After an operation, follow-up care is more targeted because the myocardial ischemia is already more advanced and surgical interventions generally put a strain on the patient. The goals of follow-up care are the same as for drug therapy. In both cases, follow-up care must be scheduled over the long term in order to maintain the success of the treatment in the future.

You can do that yourself

The diet of those affected should be as low in sugar and cholesterol as possible. But it is rich in a wide range of vitamins , different minerals and trace elements as well as roughage . When choosing fats, it is particularly important to ensure that only unsaturated fatty acids are included in the diet. Native oils such as coconut oil , olive oil and linseed oil are very suitable for this . It is also important that patients drink enough water every day. Those affected should drink at least 1.5 to 2 liters of pure water, unsweetened juices or herbal tea.

Above all, daily exercise is particularly important, preferably outside in the fresh air. An hour of brisk walking can already have an effect. Sporting activities provide the body with more oxygen. Sports such as jogging, swimming, cycling and solid endurance training are well suited. If you are overweight, it is advisable to bring the weight down to a normal weight in a gentle way, because the excess mass makes it difficult for the heart to do its work. Smokers are strongly advised to stop smoking.

Nature also has some helpers ready for those affected. The hawthorn is primarily used here . It is said to improve cardiac output and expand the coronary arteries. This improves the oxygen supply in the blood. Bishop ‘s herb can be used to optimize cardiac blood flow .

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.