• Tsuyoshi Saito, Masami Kita, Hiroshi Taguchi, Hidetsugu Tsuchimochi, Hiroshi Chida, Takashi Inamatsu, and Mayumi Mori.
• Department of Clinical Laboratory, Tokyo Metropolitan Geriatric Medical Center, Itabashi-ku, Tokyo 173-0015.
• Rinsho Byori. 2004 Oct 1;52(10):799-803.

PurposeMyocardial infarction without chest pain occurs in high incidence in elderly. However, the pathophysiological significance of the silent ischemia is still unknown. To elucidate the significance of the "painless" symptom during myocardial ischemia induced by exercise, we analyzed the incidence of silent ischemia on treadmill tests and attempted to examine the severity of the coronary stenosis in such painless subjects.Method And ResultsTreadmill test was conducted on 580 patients aged 65 to 92 years (man: 261, woman: 319) with suspected myocardial ischemia. One hundred and seventy-nine patients (man: 89, woman: 90) showed positive results. Among them 126 patients (70%) did not complain of chest pain (painless group) during treadmill tests of these. Forty four patients showed dyspnea and 82 patients did not have any symptoms during the tests. The incidence of painless ischemia tended to increase in women (77%) over men (62%) (p=0.02). The incidence of diabetes in the painless group did not differed from that in the group of patients with chest pain. Coronary angiography was conducted on 79 patients (31: chest pain group, 15: painless group with dyspnea, 33: painless group without dyspnea). Coronary artery stenosis more than 75% were observed in 25 (80%), 13 (86%) and 24 (73%) patients respectively, suggesting chest pain itself did not mean the existence of severe coronary disease.ConclusionPainless ischemia during the treadmill test was found in high incidence in the elderly. Painless ischemia must be treated as same as ischemia with chest pain.

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