Silent ischemia is a condition where the flow of oxygen-rich blood to a part of the heart muscle is restricted. If the ischemia is severe or lasts too long, it can cause a heart attack and can lead to heart tissue death. This usually causes chest pain. In some cases, however, there is no pain. These cases are called silent ischemia.

Silent ischemia may also disturb the heart’s rhythm, interfere with the heart’s pumping ability and cause fainting or even sudden cardiac death.

People are at increased risk for silent ischemia if they have had a previous heart attack, coronary artery disease, diabetes, hypertension, cardiomyopathy, substance and alcohol abuse, smoke and are obese.

Silent ischemia has no symptoms. However, studies have revealed that people who experience episodes of noticeable chest pain may also have episodes of silent ischemia.


Your doctor will perform a physical examination, ask about your symptoms and discuss your medical history. He will suggest one or more diagnostic tests. These include:

  • Exercise stress test –you exercise to make your heart work hard and beat fast. This will show blood flow through your coronary arteries in response to exercise.
  • Holter monitoring – you wear a portable monitor for 24 hours as you go about your normal activities. It records the heart’s electrical signals for a full 24- or 48-hour period. This allows the doctor monitor to see if you have had episodes of silent ischemia.



Treatment for silent ischemia is similar to treatment for any form of cardiovascular disease, and may include lifestyle changes, medications and surgery.

Lifestyle changes include:

  • Quitting smoking
  • Losing excess pounds or maintaining a healthy weight
  • Avoiding alcohol
  • Eating a heart-healthy diet
  • Being physically active
  • Monitoring blood pressure, blood sugar and cholesterol

Medications may be prescribed to prevent blood clots from forming. Anti-hypertension medications may also be given to slow heart rate, relax blood vessels, and reduce the burden on the heart.

Surgical procedures, such as a heart bypass, may be needed for some patients who do not respond to medications.

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