Asymptomatic Myocardial Ischaemia
A 62-year-old male with a history of type 2 diabetes, hypertension, and hyperlipidaemia visits his primary care physician for a routine check-up. He denies any chest pain, shortness of breath, or fatigue. He reports being generally active and able to perform daily activities without difficulty. He has no history of smoking or alcohol use. His diabetes is managed with oral medication, and his blood pressure is well-controlled with antihypertensives.
During the visit, his physician orders routine blood work and an electrocardiogram (ECG) due to his cardiovascular risk factors. The ECG reveals signs of ischemia, including ST-segment depression in the lateral leads. The patient is surprised, as he has not experienced any chest discomfort or other symptoms. Further evaluation with a stress test confirms reduced blood flow to parts of the heart during exercise, consistent with myocardial ischemia.
The patient is diagnosed with asymptomatic (silent) myocardial ischemia. He is started on beta-blockers and statins to reduce his risk of future cardiovascular events. He is also advised to make lifestyle changes, including a heart-healthy diet and regular exercise, and to closely monitor his blood sugar and blood pressure. A follow-up appointment is scheduled to reassess his condition and adjust his treatment plan as needed.
A) Stable angina
B) Asymptomatic myocardial ischemia
C) Myocardial infarction
D) Unstable angina
A) Severe chest pain and shortness of breath
B) ST-segment depression or T-wave inversion on an ECG
C) Elevated cardiac biomarkers
D) Significant coronary artery blockage visible on angiography
A) Antiplatelet therapy and nitrate therapy
B) Beta-blockers and statins
C) Surgical intervention (e.g., coronary artery bypass)
D) Immediate angioplasty
A) Increase physical activity and high-fat diet
B) Quit smoking and adopt a heart-healthy diet
C) Reduce fluid intake and increase sodium consumption
D) Avoid all physical exercise and rest frequently
