Silent myocardial ischemia

Introduction: Myocardial infarction (MI) can be manifested by anginal pain, symptoms of cardiac failure or cardiac dysrhythmias. However, MI is not always accompanied by symptoms and then it is referred to as asymptomatic or silent MI (SMI). SMI is defined as the presence of myocardial ischemia in the absence of pain. It is often accompanied by a feeling of breathlessness or fatigue. Manifest ischemia, as well as the symptomatic, is the condition of reduced oxygen supply and inappropriate accumulation of metabolic products due to a reduced perfusion of the cardiac muscle. Objective The aim of this study was to highlight the importance of emergency medical assistance in identifying out-of-hospital diagnosed SMI, based on a detailed illness history, physical examination, and ECG monitoring. Case report: A female patient with SMI is presented. Except for a mild chest pain grade 4/10 and fatigue, the patient did not feel any other symptoms characteristic of MI. Owing to a thorough illness history, physical examination and ECG, the EMS team recognized SMI. Objectively, the patient was conscious, oriented, eupneic, cardiacally compensated, of normal discoloration of skin and mucosa, with normal pulmonary state, cardiac action rhythmic, and without precordial murmurs. BP in both arms was 220/120 mmHg. The patient's ECG recording was done which showed ST depression in the inferolateral leads (D2, D3 and aVF, V4-V6). As the patient had neither previous myocardial infarction nor history of ischemic heart disease, SMI was highly suspected. Conclusion Detection of MI in symptomatic or asymptomatic patients is significant because of its unfavourable influence on disease prognosis. Anginal pain is an important symptom of MI that brings patients to a doctor; SMI should be actively searched, even by EM physicians under out-of-hospital conditions.