A Silent Myocardial Infarction at Diabetic Outpatient Clinic: Tertiary Hospital Setting

Main Article Content

Febyan .
I. Kadek Susila Darma
I. Made Suwidnya


A silent myocardial infarction (SMI) is a rare phenomenon. It occurs when the patient has many comorbidities, one of which is diabetes mellitus (DM). The underlying pathology is cardiac autonomic neuropathy (CAN), which is a serious and common complication of diabetes. We presented a unique case of a patient with asymptomatic myocardial infarction with bradycardia and DM on medication. We aim to emphasize the importance of diagnostic screening for diabetic patients using electrocardiography serials to provide adequate and prompt management of SMI and prevent further complications caused by myocardial infarction events.

Myocardial infarction, diabetes mellitus, acute coronary syndrome, STEMI

Article Details

How to Cite
., F., Darma, I. K. S., & Suwidnya, I. M. (2020). A Silent Myocardial Infarction at Diabetic Outpatient Clinic: Tertiary Hospital Setting. Asian Journal of Research in Cardiovascular Diseases, 2(2), 22-28. Retrieved from https://journalijrrc.com/index.php/AJRCD/article/view/30103
Case study


Franklin K, Goldberg RJ, Spencer F, Klein W, Budaj A, Brieger D, et al. Implications of diabetes in patients with acute coronary syndromes. Arch Intern Med. 2004;164: 1457-63.

Dioum M, Mbaye A, Ngaide A, Barry A, Leye M, Ndiaye M, et al. Prevalence and management of acute coronary syndrome with persistent ST-segment elevation in cardiology unit of General Hospital of Grand Yoff in Dakar (Experience a Single Center). J Cardiovasc Dis Diagn. 2016;5:1.

Registry of Acute and Intensive Cardiac Outcome (RAICOM) at Intensive Cardiovascular Care Unit (ICVCU) National Cardiovascular Center Harapan Kita (NCCHK); 2015.

Soomro T, Memon AG, Memon S. Frequency of acute myocardial infarction in patients with diabetes mellitus. J Liaquat Uni Med Health Sci. 2016;15(1):35-9.

Shetty V, Jain HR, Singh GS, Shetty S. Cardiac complications of diabetes mellitus: A prospective study. International Journal of Scientific Study. 2016;3(12):67-71.

Gul Z, Makaryus AN. Silent myocardial ischemia [Internet]. Treasure Island (FL): StatPearls Publishing. 2019.

Available:https://www.ncbi.nlm.nih.gov/books/ NBK536915/

[Accessed on April 27th 2020]

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Pedoman tatalaksana sindrom coroner akut. PERKI. 2015;3:43-70.

Iqbal MJ, Javed MT, Tahira I. Complications and mortality in ST-segment elevation acute myocardial infarction in diabetic and non-diabetic patients. Medical Journal of Islamic World Academy of Sciences. 2011;19(2):87-94.

Draman MS, Thabit H, Kiernan TJ, O’neill J, Sreenan S, McDermott JH. A silent myocardial infarction in the diabetes outpatient clinic: Case report and review of the literature. Endocrinol Diabetes Metab Case Rep. 2013;2013:130058.

Serhiyenko VA, Serhiyenko AA. Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment. World J Diabetes. 2018;9(1):1-24.

Ahmed AH, Shankar K, Eftekhari H, Munir M, Robertson J, Brewer A, et al. Silent myocardial ischemia: Current perspectives and future directions. Exp Clin Cardiol. 2007;12(4):189-96.

Fornengo P, Bosio A, Epifani G, Pallisco O, Mancuso A, Pascale C. Prevalence of silent myocardial ischaemia in new-onset middle-aged type 2 diabetic patients without other cardiovascular risk factors. Diabet Med. 2006;23:775-79.

Boras J, Brkljacic N, Ljubicic A, Ljubic S. Silent ischemia and diabetes mellitus. Vuk Vrhovac University Clinic. 2010;39(2):57-63.

Mohammed I, El Zaatari MS, Tyrogalas N, Khalid MI. Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: Is it common?. BMJ Case Rep. 2014;1-5.

O’Gara PT, Kushner FG, Ascheim DD, Zuber M, Casey Jr DE, Chung MK, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013:61.

Erne P, Schoenenberger AW, Burckhardt D, Zuber M, Kiowski W, Buser PT, et al. Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial. JAMA. 2007; 297(18):1985-91.

Doi S, Suzuki M, Funamizu T, Takamisawa I, Tobaru T, Daida H, et al. Clinical features of potential after-effects of percutaneous coronary intervention in the treatment of silent myocardial ischemia. Heart Vessels. 2019;34(12):1917-24.

Deshpande A, Birnbaum Y. ST-segment elevation: Distinguishing ST elevation myocardial infarction from ST elevation secondary to nonischemic etiologies. World J Cardiol. 2014;6(10):1067-79.

American Diabetes Association. Standards of medical care in diabetes – 2011. Diabetes Care. 2011;34(1):S11–S61.

Curry SJ. Screening for cardiovascular disease risk with electrocardiography, US Preventive services task force recommendation statement. JAMA. 2018; 2308-14.

Khanal S, Rao GR, Sood A, Dutta P. Effective early screening modalities for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus. J Cardiovasc Disease Res. 2018;9(2): 63-7.