Is it silent myocardial ischemia?! - case report

Abstract

Introduction: Silent myocardial ischemia is defined as objective documentation of myocardial ischemia in the absence of angina or anginal equivalents. Silent ischemia is an intriguing phenomenon and is causally related to serious or fatal cardiac events. Histopathological studies give credence to the idea that recurrent ischemia may cause irreversible myocardial changes related to the development of fibrotic myocardium which would act as an ideal substrate for the development of life-threatening arrhythmias or lead to the development of congestive heart failure. Case report: We present the case of a 62 year old patient, which prior to a non-cardiac surgical procedure discovered accidentally ischemic modifications on the ECG (ST segment depression and negative T waves in V3-V6). Thus, he was sent for further cardiological investigations. The patient had no history of cardiovascular pathology, being an occasional smoker. During the clinical examination the only thing that stood out was that he had a BMI of 27.4 kg/m”. Hematological analyses showed a slightly raised total cholesterol and LDL-cholesterol. The echocardiography was normal and excluded a left ventricular hypertrophy or an obstructive hypertrophic cardiomyopathy. He was referred to an ECG exercise stress test that revealed positivation of T waves but with no symptoms of angina during the test. Finally, in order to certify coronary lesions, the patient was submitted to a computerized tomographic angiography that showed permeable arteries, with no stenosis. Discussions and Conclusions: Considering all the information mentioned above, the case of this patient is challenging because of the ischemic modifications on the EKG with no organic underneath causes. In the future, the patient will continue the scheduled follow-up in the clinic.