While painful or "noisy" ischemia (angina) often results from physical stress, like climbing stairs, even slight exertions, like balancing a checkbook, can trigger silent ischemia.
A paper published last year in the journal Angiology found 10 odd cases in France of heavy herbe smokers who developed ischemia (an insufficient blood supply) in their limbs .
Stress tests, which help doctors detect ischemia, or lack of blood flow to the cardiac muscle, can be performed using either echocardiograms or nuclear scans.