Holter Monitor Recordings in Patients with Asymptomatic Positive Exercise Thallium-201 Defects

  • Gary J. Anderson
  • Steven P. Kutalek
Conference paper

Abstract

Silent myocardial ischemia has been the subject of recent attention in the literature [1–5]. In spite of its clinical importance, the diagnostis of silent ischemia has remained unclear. While myocardial ischemia is usually accompanied by symptoms, asymptomatic episodes of ischemia have directed our diagnostic attention to the potential for laboratory diagnosis [6]. The ease with which the electrocardiogram and Holter monitor can be obtained has led clinicians to view these tools as useful for the identification of episodes of silent ischemia. Unfortunately, ST- and T-wave abnormalities are nonspecific indicators of myocardial repolarization, thus compromising the value of these changes when they do occur.

Keywords

Depression Ischemia Radionuclide Cardiol Digoxin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. [1]
    Lindsey HE Jr, Cohn PF (1978) “Silent” myocardial ischemia during and after exercise testing in patients with coronary artery disease. Am Heart J 95:441–447PubMedCrossRefGoogle Scholar
  2. [2]
    Conti C R (1980) Detection and management of the asymptomatic patient with coronary artery disease. Adv Cardiol 27:181–190PubMedGoogle Scholar
  3. [3]
    Iskandrian AS, Segal BL, Anderson GJ (1981) Asymptomatic myocardial ischemia. Arch Intern Med 141:95–97PubMedCrossRefGoogle Scholar
  4. [4]
    Kent KM, Rosing DR, Ewels CJ, Lipson L, Bonow R, Epstein SE (1982) Prognosis of asymptomatic or midly symptomatic patients with coronary artery disease. Am J Cardiol 49:1823–1831PubMedCrossRefGoogle Scholar
  5. [5]
    Cohn PF (1983) Prognosis and treatment of asymptomatic coronary artery disease. J Am Coll Cardiol 1:959–964PubMedCrossRefGoogle Scholar
  6. [6]
    Uhl GS, Froelicher V (1983) Screening for asymptomatic coronary artery disease. J Am Coll Cardiol 1:946–955PubMedCrossRefGoogle Scholar
  7. [7]
    Babey AM (1939) Painless acute infarction of the heart. N Engl J Med 22:410–412CrossRefGoogle Scholar
  8. [8]
    Roseman MD (1954) Painless myocardial infarction:a review of the literature and analysis of 220 cases. Ann Intern Med 41:1–8PubMedGoogle Scholar
  9. [9]
    Cohn PF (1980) Silent myocardial ischemia in patients with a defective anginal warning system. Am J Cardiol 45:697–702PubMedCrossRefGoogle Scholar
  10. [10]
    Droste C, Roskamm H (1983) Experimental pain measurement in patients with asymptomatic myocardial ischemia. J Am Coll Cardiol 1:940–945PubMedCrossRefGoogle Scholar
  11. [11]
    Stern S, Tzivoni D (1973) Dynamic changes in the ST-T segment during sleep in ischemic heart disease. Am J Cardiol 32:17–20PubMedCrossRefGoogle Scholar
  12. [12]
    Wolf E, Tzivoni D, Stern S (1974) Comparison of exercise tests and 24-hour ambulatory electrocardiographic monitoring in detection of ST-T changes. Br Heart J 36:90–95PubMedCrossRefGoogle Scholar
  13. [13]
    Stern S, Tzivoni D (1974) Early detection of silent ischemic heart disease by 24-hour electrocardiographic monitoring of active subjects. Br Heart J 36:481–486PubMedCrossRefGoogle Scholar
  14. [14]
    Stern S, Tzivoni D (1975) Diagnostic accuracy of ambulatory ECG monitoring in ischemic heart disease. Circulation 52:1045–1049PubMedGoogle Scholar
  15. [15]
    Allen RD, Gettes LS, Phalan C, Avington MD (1976) Painless ST-segment depression in patients with angina pectoris—correlation with daily activities and cigarette smoking. Chest 69:467–473PubMedCrossRefGoogle Scholar
  16. [16]
    Schang SJ, Pepine CJ (1977) Transient asymptomatic S-T segment depression during daily activity. Am J Cardiol 39:396–402PubMedCrossRefGoogle Scholar
  17. [17]
    Biagin A, Mazzei MG, Carpeggiani C, Testa R, Antonelli R, Michelassi C, L’Abbate A, Maseri A (1982) Vasospastic ischemic mechanism of frequent asymptomatic transient ST-T changes during continuous electrocardiographic monitoring in selected unstable angina patients. Am Heart J 103:13–19CrossRefGoogle Scholar
  18. [18]
    Cechi AC, Dovellini EV, Marchi F, Pucci P, Santoro G, Fazzini PF (1983) Silent myocardial ischemia during ambulatory electrocardiographic monitoring in patients with effort angina. J Am Coll Cardiol 1:934–939CrossRefGoogle Scholar
  19. [19]
    Johnson S M, Mauritson D R, Winniford M D, Willerson JT, Firth B G, Cary J R, Hillis LD (1982) Continuous electrocardiographic monitoring in patients with unstable angina pectoris:identification of high-risk subgroup with severe coronary disease, variant angina, and/or impaired early prognosis. Am Heart J 103:4–12PubMedCrossRefGoogle Scholar
  20. [20]
    Kunkes SH, Pichard AD, Smith H, Gorlin R, Herman M, Kupersmith J (1980) Silent ST segment deviations and extent of coronary artery disease. Am Heart J 100:813–819PubMedCrossRefGoogle Scholar
  21. [21]
    Crawford MH, Mendoza CA, O’Rourke RA, White DH, Boucher CA, Gorwit J (1978) Limitations of continuous ambulatory electrocardiogram monitoring for detecting coronary artery disease. Ann Intern Med 89:1–5PubMedGoogle Scholar
  22. [22]
    Armstrong WF, Jordan JW, Morris SN, McHenry PL (1982) Prevalence and magnitude of S-T segment and T wave abnormalities in normal men during continuous electrocardiography. Am J Cardiol 49:1638–1642PubMedCrossRefGoogle Scholar
  23. [23]
    Lachman AB, Semler HJ, Gustafson RH (1965) Postural ST-T wave changes in the radioelectrocardiogram simulating myocardial ischemia. Circulation 31:557–563PubMedGoogle Scholar
  24. [24]
    Bailey IK, Griffith LSC, Rouleau J, Strauss H W, Pitt B (1977) Thallium-201 myocardial perfusion imaging at rest and during exercise:comparative sensitivity to electrocardiography in coronary artery disease. Circulation 55:79–87PubMedGoogle Scholar
  25. [25]
    Ritchie J L, Trobaugh GB, Hamilton G W, Gould KL, Narahara K A, Murray J A, Williams D L (1977) Myocardial imaging with thallium-201 at rest and during exercise:comparison with coronary arteriography and resting and stress electrocardiography. Circulation 56:66–71PubMedGoogle Scholar
  26. [26]
    McGowan RL, Martin ND, Zaret BL, Hall RR, Bryson AL, Strauss HW, Flamm MD (1977) Diagnostic accuracy of noninvasive myocardial imaging for coronary artery disease:an electrocardiographic and angiographic correlation. Am J Cardiol 40:6–10PubMedCrossRefGoogle Scholar
  27. [27]
    Hinkle LE Jr, Meyer J, Stevens M, Carver ST (1967), Tape recordings of the ECG of active men—limitations and advantages of the Holter-Avionics instruments. Circulation 36:752–765PubMedGoogle Scholar
  28. [28]
    Bragg-Remschel D A, Anderson CM, Winkle RA (1982) Frequency response characteristics of ambulatory ECG monitoring systems and their implications for ST segment analysis. Am Heart J 103:20–31PubMedCrossRefGoogle Scholar
  29. [29]
    Cocco G, Braun S, Strozzi C, Leishman B, Chu D, Rochat N (1982) Asymptomatic myocardial ischemia in patients with stable and typical angina pectoris. Clin Cardiol 5:403–408PubMedCrossRefGoogle Scholar
  30. [30]
    Selwyn AP, Fox K, Eves M, Oakley D, Dargie H, Shillingford J (1978) Myocardial ischemia in patients with frequent angina pectoris. Br Med J 2:1594–1596PubMedCrossRefGoogle Scholar
  31. [31]
    Doroghazi RM, Childers R (1978) Time-related changes in the Q-T interval in acute myocardial infarction:possible relation to local hypocalcemia. Am J Cardiol 41:684–688PubMedCrossRefGoogle Scholar
  32. [32]
    Abildskov J A (1976) Adrenergic effects of the Q-T interval of the electrocardiogram. Am Heart J 92:210–216PubMedCrossRefGoogle Scholar
  33. [33]
    Browne KF, Zipes DP, Heger J J, Prystowsky EN (1982) Influence of the autonomic nervous system on the Q-T interval in man. Am J Cardiol 50:1099–1103PubMedCrossRefGoogle Scholar
  34. [34]
    Schwartz PJ, Periti M, Malliani A (1975) The long Q-T syndrome. Am Heart J 89:378–390PubMedCrossRefGoogle Scholar
  35. [35]
    Ahnve S, Lundman T, Shoalen-var M (1978) The relationship between QTinterval and ventricular arrhythmias in acute myocardial infarction. Acta Med Scand 204:17–19PubMedCrossRefGoogle Scholar
  36. [36]
    Haynes RE, Hallstrom AP, Cobb LA (1978) Repolarization abnormalities in survivors of out-of-hospital ventricular fibrillation. Circulation 57:654–658PubMedGoogle Scholar
  37. [37]
    Schwartz PJ, Wolf S (1978) QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation 57:1074–1077PubMedGoogle Scholar
  38. [38]
    Puddu PE, Jouve R, Torresani J, Jouve A (1981) QT interval and primary ventricular fibrillation in acute myocardial infarction. Am Heart J 101:118CrossRefGoogle Scholar
  39. [39]
    Taylor GJ, Crampton RS, Gibson RS, Stebbins PT, Waldman MTG, Beller GA (1981) Prolonged QT interval at onset of acute myocardial infarction in predicting early phase ventricular tachycardia. Am Heart J 102:16–24PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin, Heidelberg 1984

Authors and Affiliations

  • Gary J. Anderson
  • Steven P. Kutalek

There are no affiliations available

Personalised recommendations