Excerpt

The prevalence of asymptomatic myocardial infarction (MI) had been reported to be 33% in large registry data, with a minority of asymptomatic MIs presenting as ST-segment elevation myocardial infarction (STEMI).1 Risk factors for asymptomatic presentation are female gender, age > 75, history of diabetes mellitus, stroke or heart failure, and history of orthotopic heart transplantation (OHT). The clinical presentation of MI in patients with OHT was first reported in 1989 by Gao et al.2 who described a high proportion of OHT recipients presenting with atypical or no symptoms of coronary artery disease (CAD). It is now known that the lack of afferent pain fibers in denervated heart allograft recipients results in a lack of angina in this population. Thus, clinicians must have a high level of suspicion for CAD in heart transplant recipients. This has led to the creation of surveillance protocols with either serial left heart catheterizations (LHC) and more recently with positron emission tomography (PET) with myocardial blood flow quantification at rest and stress. …