A 62-year-old man with type 2 diabetes undergoes pre-operative cardiac risk assessment for elective abdominal surgery. He denies any chest pain or dyspnea. A dobutamine stress echocardiogram demonstrates anterior wall hypokinesis at high-dose dobutamine. Which term best describes this scenario?

• A Silent myocardial ischemia ✓
• B Unstable angina
• C Stable angina equivalent
• D Non-ischemic cardiomyopathy

Explanation

Silent myocardial ischemia is defined as objective evidence of ischemia (ST changes, wall motion abnormality on stress testing) without anginal symptoms. Diabetes mellitus is a classic risk factor due to autonomic neuropathy causing cardiac denervation. It carries the same prognostic significance as symptomatic ischemia. 'Stable angina equivalent' is not a standard term. Unstable angina involves symptoms at rest or crescendo pattern.

Reference: Braunwald's Heart Disease, 12th ed.

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