Silent ischemia during mental stress: Scintigraphic evidence and electrocardiographic patterns

L. Tavazzi, E. Bosimini, R. Giubbini, M. Galli, G. Mazzuero

Research output: Contribution to journalArticlepeer-review


In general, in highly industrialized countries, psychological stress has often replaced physical stress at the most commonly perceived cardiovascular demand during daily life. In patients with ischemic heart disease recent studies with Holter monitoring have shown that the majority of episodes of transient myocardial ischemia are silent and often occur during non-exertional activities including those involving mental rather than physical stress [1-4]. They are not accompanied by noteworthy increase in heart rate and the ischemic threshold is often lower than that observed during physical exercise [2-5]. Moreover it is now clear that silent myocardial ischemia involves the same sequence of physiologic events documented during symptomatic ischemic episodes, except that chest pain is not present, and recent data suggest that the presence of silent ischemia is indicative of an increased risk of future cardiac events [6]. In spite of this, among the clinical and laboratory variables related to prognostic end points in CAD patients, silent myocardial ischemia induced by psychological arousal has been largely overlooked. This attitude is mainly related to the difficulties of detection of such episodes frequently not accompanied by definite electrocardiographic modifications. Accordingly there has been recent interest in applying sensitive methods, such as imaging techniques, in detecting mental stress-induced transient ischemic episodes. Aim of this paper is to report briefly our experience and the inplications of new knowledge in this area.

Original languageEnglish
Pages (from-to)53-66
Number of pages14
JournalAdvances in Cardiology
Publication statusPublished - 1990

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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