Diagnosis and Treatment > Investigation > Electrocardiogram

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M S Draman Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

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H Thabit Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

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T J Kiernan Department of Cardiology, University of Limerick, Limerick, Ireland

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J O'Neill Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

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S Sreenan Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

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J H McDermott Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

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Summary

Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.

Learning points

  • Silent myocardial ischaemia (SMI) is an important clinical entity.

  • SMI is common and occurs with increased frequency in patients with diabetes.

  • SMI is an independent predictor of mortality.

  • Recognition may lead to early intervention.

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