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Silent ischaemia causing a chronic total occlusion of a heart artery

A patient of mine who only had mild high cholesterol levels and no history of heart disease, underwent a routine screening stress test. At stage 2 of the exercise test, significant ECG changes were detected suggestive of a narrowing of the heart arteries due to coronary ischaemia (reduced blood supply to a region of the heart).

The patient agreed to have a coronary angiogram which showed a long occluded segment of the mid LAD. Careful passage of a guidewire and an angiogram of the RCA confirmed that the guidewire had passed through the blockage into the distal portion (true lumen). Coronary angioplasty and placement of two stents led to a successful opening of the blocked artery (chronc total occlusion).

Many people may have heart ischaemia without knowing anything about it (silent ischaemia). They may also have had a heart attack without any warning. Having a stress test is an easy non-invasive test to detect this problem.

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