Myocardial Ischemia — Silent or Symptomatic

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Abstract
ALTHOUGH "silent ischemia" has recently captured the imagination of investigators and physicians, it is by no means a new concept. One of Holter's two earliest publications included ambulatory electrocardiographic recordings depicting asymptomatic episodes of spontaneously occurring ST-segment depression.1 In addition, ST-segment depression, appearing in the absence of angina pectoris, was recognized during electrocardiographic exercise stress testing as early as the 1930s,2 and ischemic electrocardiographic changes occurring during exercise stress testing have long been routinely used for diagnostic and prognostic purposes without reference to the presence or absence of accompanying angina.3 , 4 Nonetheless, silent ischemia has recently emerged as a topic of . . .