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The British Journal of Diabetes & Vascular Disease
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Review: Mechanisms of silent myocardial ischaemia: with particular reference to diabetes mellitus

Marc Dweck

Department of Cardiology, Victoria Hospital, Kirkcaldy, UK

Douglas Miller

University of St Andrews, St Andrews, UK

Ian W Campbell

University of St Andrews, St Andrews, UK

C Mark Francis

Department of Cardiology, Victoria Hospital, Kirkcaldy, UK, mark.francis{at}faht.scot.nhs.uk

Angina occurs relatively late following the onset of ischaemia: after the development of left ventricular dysfunction and electrocardiographic changes. Most ischaemic episodes are not severe enough or long enough to fully stimulate the anginal pain pathway. They are therefore clinically silent. More severe and prolonged episodes of ischaemia can also be silent. Pain thresholds vary between individuals and this is due to differences in gating mechanisms at the level of the thalamus. This gating appears to be modulated by levels of endogenous endorphins, among other mechanisms. This seems to have a relation to personality type. Silent ischemia is especially common in diabetic patients, and is often due to cardiac autonomic neuropathy.

Key Words: diabetes • ischaemia • myocardial • silent

The British Journal of Diabetes & Vascular Disease, Vol. 9, No. 3, 99-102 (2009)
DOI: 10.1177/1474651409105371
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M. Dweck, I. W Campbell, D. Miller, and C M. Francis
Clinical aspects of silent myocardial ischaemia: with particular reference to diabetes mellitus
The British Journal of Diabetes & Vascular Disease, May 1, 2009; 9(3): 110 - 116.
[Abstract] [PDF]