Whatever happened to silent ischaemia?

Myocardial ischaemia is a reliable predictor of significant coronary artery disease (CAD). During an episode of myocardial ischaemia, anginal pain may appear late or not at all, even in the presence of ischaemic changes on the electrocardiogram (ECG). This phenomenon of silent ischaemia was first described by Stern and Tzivoni in 1974.1 As many as 70% of daily ischaemic episodes in stable CAD and 90% of episodes in unstable angina are silent.