Aim: To determine the peculiarities of the course of silent myocardial ischemia (SMI) in patients with post-infarction cardiosclerosis depending on the risk factors (RFs); to reveal the interdependence between the presence of pathological turbulence of the heart rhythm and the peculiarities of the course of SMI in patients with post-infarction cardiosclerosis and the effectiveness of treatment applying S-amlodipine and enalapril in complex therapy. Materials and Methods: There were observed 154 patients with SMI with a history of myocardial infarction, having received anti-anginal therapy. The diagnosis of SMI was made according to Holter ECG monitoring data. Among the additional indices of the severity of the patient’s condition, the maximum value of the ST segment deviation amplitude was evaluated. Results: It was determined that in patients with SMI with post-infarction cardiosclerosis, there is a positive correlation between the presence of RFs and Holter ECG monitoring indices, in particular, the average daily values of the number of ischemic episodes, the total daily duration of ST segment depression and the average duration of one ischemic episode. Enalapril and S-amlodipine are the effective means of pharmacotherapy in the SMI. Conclusions: The silent myocardial ischemia, which is associated with the presence of such Rfs as arterial hypertension, diabetes melitus, dyslipidemia or their combination, is characterized by a severe course of the disease, which is manifested by a worsening of the clinical condition, a decrease in tolerance to physical exertion, significant changes in hemodynamics.