The absent or atypical clinical signs in elderly persons hinder the management of coronary atherosclerotic disease. The cases of myocardial ischemia without pain, the so-called asymptomatic or silent ischemia, it is more frequent in elderly patient2. Considering patients with acute coronary syndrome, as myocardial infarction with ST-segment elevation, among those under 65 years of age, only 11....

Chest pain caused by myocardial ischemia is mediated by cardiac sympathetic afferents. Although silent nociceptors exist in somatic structures and some visceral organs, their presence in the heart remains uncertain. The present study examined the presence and the functional characteristics of mechanically insensitive cardiac sympathetic afferents using an electrical search technique. Single-uni...

BACKGROUND AND PURPOSE Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. METHODS We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultra...

The clinical implications of silent myocardial ischemic (SMI) episodes in patients with coronary artery disease were assessed in 253 patients whose angina symptoms were resolved by antianginal drugs. This population included 93 patients without a history of myocardial infarction (angina group) and 160 patients with myocardial infarction (infarction group). These patients were further divided in...

Silent myocardial ischemia (SMI) is defined as the presence of objective evidence of myocardial ischemia in the absence of chest discomfort or other anginal equivalents. Most silent ischemic episodes occur during minimal or no physical exertion. The exact reasons for the development of angina during some episodes of myocardial ischemia and the absence of symptoms during other episodes are not k...

BACKGROUND Myocardial perfusion imaging (MPI) is a powerful diagnostic and prognostic tool for evaluating coronary artery disease (CAD). Several studies have shown Type 2 diabetics are at increased risk for having CAD. In addition, insulin resistance is generally considered to be of major importance in the pathophysiology of Type 2 diabetes mellitus. However, the area of screening prediabetics ...

Background and Purpose—Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. Methods—We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultraso...

Myocardial ischemia is well established as a reliable predictor of physiologically significant coronary artery disease (CAD) (1,2). During the past two decades, a large number of epidemiologic studies and prospective observational data have demonstrated that the presence of myocardial ischemia is associated with adverse outcomes in asymptomatic individuals as well as those with established CAD ...

We may never know whether the accuracy of William Heberden’s description in the 1770s of a new syndrome, centering around pain in the left chest and named by him “angina pectoris,” occurred because the author himself experienced the symptoms described.1 Heberden’s description of the symptoms has prevailed for centuries, as if it were written in stone. Decades later, this “pain in the chest” was...