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Minerva Medicolegale 2013 March;133(1):5-17


language: Italian

The silent myocardial ischemia: general criteria of medico-legal evaluation

Molisso V. 1, Pietrantuono C. 2, Molisso C. 3, Forni F. 4, Cullia D. 5, Massimelli M. 5, Piccioni M. 6

1 Medico-Legale Convenzionato INPS, Unità Operativa Complessa Napoli 2, Napoli, Italia; 2 Coordinatore Medico-Legale INPS, Unità Operativa Complessa Napoli 2, Napoli, Italia; 3 Dirigente Servizio Cardiologia, UOS Centro Polispecialistico Regionale INPS per la Campania, Napoli, Italia; 4 Medico-Legale convenzionato INPS, Unità Operativa Complessa Napoli 5, Napoli, Italia; 5 Coordinatore UOS, Centro Polispecialistico Regionale INPS per la Campania, Napoli, Italia; 6 Medico-Legale, Torino, Italia; 7 Coordinatore Generale Medico-Legale INPS Roma, Roma, Italia


The socalled silent myocardial ischemia is characterized by instrumental evidence of cardiac ischemia in the absence of anginal symptoms or its equivalent. The emergence of silent myocardial ischemia and its causal competition with various other forms of ischemic heart disease in the determination of cardiovascular damage accounts for the need for both a diagnostic procedure performed and an accurate medical-legal framework, aimed to quantifying the disability itself and its role in the measurement of the damage, especially in the post-infarction. According to Cohn, in the asymptomatic population (group I), the silent myocardial ischemia, highlighted by the stress test and/or Holter-ECG, involves a hypothetical increase in the risk of cardiac events, although the lack of specificity and sensitivity of these tests may not be predictive of a poor prognosis (with consequent little value medico-legal), whereas in subjects belonging to group II (postinfarction) and III (mixed symptomatic and asymptomatic ischemia) the prognostic factor becomes significant element in the formulation of the final medico-legal evaluation. After a wide analysis of the explicit normative references and of the most adjourned doctrinaire table indications, the authors propose some guidelines of a medico-legal evaluation of the biological damage and of the working inability, especially after the myocardial infarction (according the law 222/1984) based on analysis of the following parameters: importance of the left ventricular dysfunction and of stress ischaemia, degree of tolerance to the exercise, extension of the perfusion defect to the myocardial scanning and features of the ventricular arrhythmias if present (when they are agree with the mentioned index).

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