The state of art in the treatment of silent myocardial ischemia is reviewed in such a way as to provide with the cardiologist information for the correct decision to be made in patients with ischemia, but without clinical symptoms of angina and its equivalents. Previewed-required, the concept, the classification and the diagnostic methods were reviewed. The prognosis, pharmacological treatment, intervention procedures and their results on the natural history of the disease are emphasised. It is recommended that the treatment of silent ischemia be done, at first, with primary and secondary prevention, and with pharmacological therapy. It is assumed that with the reduction of general ischemic episodes, survival can be individualized. New techniques have been introduced that modify the results in both the short and long term of these procedures.