Painless ischemic heart disease is the form of atherosclerotic coronary artery disease in which pain is absent. The disease is detected on the basis of an anamnesis, clinical examination and additional investigations: EKG, echocardiography, exercise stress test, holter EKG, etc.

It can manifest as:

• Ischemic heart failure. In general, it occurs in the setting of multiple coronary artery disease, with or without a history of myocardial infarction, sometimes in the context of associated diseases (hypertension, diabetes mellitus, kidney disease);
• Rhythm/driving disturbances: a common manifestation in myocardial ischemia, which produces an electrical instability and causes condu conduction disturbances (blocks of varying severity up to complete block requiring cardio-stimulation) and/or rhythm disturbances/cardiac arrhythmias (atrial arrhythmias: atrial extrasystoles, atrial fibrillation, or ventricular: ventricular extrasystoles, ventricular tachycardia, ventricular fibrillation) that may require implantation of a cardiac defibrillator;
• Sudden ischemic death.