Silent myocardial ischemia. Is the person or the event silent?
A. J. Barsky, B. Hochstrasser, N. A. Coles, J. Zisfein, C. O'Donnell and K. A. Eagle
Psychiatry Service, Massachusetts General Hospital, Boston, MA 02114.
The symptoms of organic disease vary widely among patients with the same
tissue abnormality, because the experience of a symptom is shaped by the
patient's perceptual and cognitive style. Thus, the relationship between
myocardial ischemia and chest pain is variable in that many patients
experience pain without ischemia and many others exhibit ischemia without
pain-termed "silent" or "asymptomatic ischemia." Although the nature of the
ischemic event may be important in determining the degree of associated
pain, we suggest more study of the individual who perceives the event.
Myocardial ischemia may not generate a spontaneous report of chest pain
because the patient is generally hyposensitive to visceral sensation;
because he or she is coping with the threat of heart disease by denying the
evidence of it--ie, denying the pain to deny the disease; or because the
patient misunderstands the cause and significance of a vague or ambiguous
cardiac sensation, normalizing the symptom and misattributing it to a
nonpathologic cause.
