Hello, Thanks for posting your query on Healthcare Magic... * Brief Answer: silent ischemia happens in diabeteic patient.basic clinical examination ,electrocardiogram and echocardiogram are more simple. Explanation: My opinion is that coronary heart disease sometimes is a tricky diagnosis,but basics are basics .Chest pain may be typical or atypical in some patients. In diabetes ,as for autonomic neuropathy, pain may not be present.Basic history taking and risk factor assessment is crucial .investigations like electrocardiogram and echo are important , In some borderline complaints stress testing may be done. I suggest my patients the following: invasive procedure as coronary angiography should be preseved to proved cases of ischemia or borderline cases with confusing results. The information provided by you is not sufficient to provide a good opinion. If someone comes to me with this condition I would ask them about any symptoms you experience especially in stress or with effort. *Conclusion: I suggest you start with basic assessment first, then proceed accordingly. If you have any further questions I will be happy to help, If not, you can close the discussion and rate the answer. Wish you good health.