Silent Myocardial Ischemia and Infarction. 2nd Edition

337 all levels, especially infectious disease specialists, immunologists, clinical microbiologists , and research scientists. This volume would be particularly useful to physicians who treat patients with AIDS, and to others who desire a comprehensive, yet readable, up-to-date discussion of the research and clinical aspects of AIDS. Silent myocardial ischemia is defined as objective evidence of myocardial ischemia without chest pain or other anginal equivalents. Silent Myocardial Ischmemia and Cardiology at Stony Brook, is an attempt to update his first book, which was published in 1986. The present book is divided into five sections that focus on the pathophysiol-ogy, prevalence, detection, prognosis, and management of silent ischemia. In order to examine these issues more closely, Cohn defines three types of settings in which silent ischemia occurs: (1) in persons who are totally asymptomatic, (2) in persons who are asymptomatic following a myocardial infarction but still demonstrate active ischemia, and (3) in persons with a history of angina who are asymptomatic with some episodes of myocardial ischemia, but not others. The section on prevalence of silent ischemia and infarctions was the most interesting and enlightening part of this book. It is noted that the actual number of people with silent ischemia is unknown, but that autopsy studies have shown that the mean prevalence of coronary artery disease in asymptomatic individuals is 4.5 percent and is as high as 12.3 percent in men aged 60 to 69. Furthermore, it has been estimated that about one-third of all patients who have evidence of post-infarction ischemia by Holter monitoring, exercise stress testing, or radionuclide procedures do not experience angina. This estimate suggests that about 50,000 people each year have ischemia after their heart attacks without clinical symptoms. This statement is even more intriguing because of the possible relationship between sudden death and myocardial infarction in patients without prior histories of angina. Studies have found that between one-quarter and one-half of people with coronary artery disease who die of "sudden death" each year had no prior cardiac disease history. The book is full of interesting studies which convincingly conclude that silent ischemia is extremely common and has very important prognostic implications. It becomes clear that angina is just one marker of cardiac ischemia and the lack of it in someone with demonstrated ischemia is possibly irrelevant. The strengths of this volume are twofold. The most important is its content: it provides a most up-to-date summary of …