PRACTICAL VALUE OF THE DETECTION BY HOLTER OF SILENT-MYOCARDIAL-ISCHEMIA IN CORONARY-DISEASE PATIENTS

The prognosis of painless myocardial ischemia is similar to that of sy mptomatic ischemia. The Holter technique (and solid memory Holter in p articular) is a simple method of detection which, taken together with exercice testing, enables the identification among coronary disease pa tients of a high risk group in whom effort ischemia is accompanied by episodes of ischemia under everyday conditions and in whom additional investigations (exercise thallium scan then coronary arteriography) an d appropriate treatment, including transluminal angioplasty and aorto- coronary bypass if necessary, may be required. The role of drug treatm ent in silent ischemia has not yet been clearly defined. While electri cal ischemia regresses significantly with the majority of standard dru g regimens, and beta-blockers in particular, none has yet been confirm ed as having a preventive effect against serious events following on f rom silent myocardial ischemia.