"Silent Ischemia, Current Concepts and Management" contains the proceedings of a conference held in Rottach-Egern, West Germany, March 5 to 7, 1987. We are most grateful to the authors for the effort to provide manuscripts before the meeting, to the sponsor, Bayer AG, for their generous support and to the publishers for their efficient collaboration, all of which have made the appearance of this book possible. When discussing silent myocardial ischemia, the first question is: "why is it silent?". To approach this question, a deeper look has to be taken into the pathophysiology of cardiac pain and the excitatory and inhibitory mechanisms involved. It has to be borne in mind that - in contradiction to what the poets have told us so beautifully for many centuries - the heart is a visceral and not a sensitive organ. If asymptomatic ischemia did not carry prognostic significance comparable to the symp tomatic manifestations of ischemia, then the problem of silent ischemia would be very academic and without consequences for treatment. Therefore studies on prognosis of silent ischemia are of great importance, as their results should indicate how aggressively patients are to be managed.

Central mechanisms of pain control: a survey

Peripheral innervation of the heart
Pathophysiology of ischemic cardiac pain
Alpha-receptors and transient ischemia
Experimental approach to painful and painless ischemia
Silent myocardial ischemia in middle aged men: Long term clinical course
Prognostic implications of silent ischemia in patients with stable angina pectoris
Silent myocardial ischemia in unstable angina: Prognostic considerations
Prevalence of ventricular arrhythmias during silent myocardial ischemia
Arrhythmogenic potential of silent myocardial ischemia after myocardial infarction
Prevalence of silent ischemia in patients undergoing coronary angiography
Identification of patients with silent myocardial ischemia by metabolic, scintigraphic and angiographic findings
The frequency, pathophysiology, and prognosis of exercise-induced silent ischemia
Regional wall motion disorders during exercise with and without angina
Non invasive detection of silent myocardial ischemia with echocardiography
Symptomatic versus asymptomatic ischemic episodes during Holter monitoring: patterns of high resolution trend recordings of ST segment and heart rate
Silent ischemia and coronary anatomy
Dedicated ST-segment monitoring in the CCU after successful coronary angioplasty: incidence and prognosis of silent and symptomatic ischemia
Hemodynamics of painless ischemia
Medical and surgical therapy of patients with asymptomatic ischemia
Coronary angioplasty in silent myocardial ischemia
Alleviation of silent ischemia by PTCA
Guiding anti-ischemic therapy by Holter monitoring
Silent myocardial ischemia: Current concepts and management
Importance of silent myocardial ischemia in therapy for unstable angina pectoris
Variability of myocardial ischemia in chronic stable angina
Clinical significance of silent myocardial ischemia.