Diagnosis and prognosis of silent ischemia.

Patients with coronary disease react differently to ischemia. Some (types I and II) experience no symptoms, while most patients with silent ischemia have both symptomatic and asymptomatic ischemia. The best evidence suggests that prognosis is determined by the amount of ischemia, not its presentation. In addition, in these patients, silent ischemia during daily living is not common. Prospective prognostic studies have not been performed in patients who do not experience angina with ischemia, therefore treatment must be individualized in these patients, considering the lack of a "warning system".