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[In which type of hypertension should ventricular hyperexcitability be suspected?]
M Galinier1, B Fermond, V Lambert
1Service de cardiologie clinique et expérimentale, CHU Rangueil, Toulouse.
Insights
Ambulatory electrocardiographic monitoring (Holter monitoring) is not necessary for hypertensive patients with normal electrocardiograms. However, it is recommended for those with ST-T wave changes or significant left ventricular hypertrophy (LVH) detected via echocardiography.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Electrocardiography
Context:
- Essential hypertension poses risks for cardiac arrhythmias.
- Identifying patients needing further cardiac evaluation is crucial.
- Ambulatory electrocardiographic monitoring aids in detecting ventricular arrhythmias.
Purpose:
- To establish guidelines for the necessity of Holter monitoring in hypertensive patients.
- To correlate electrocardiogram (ECG) and echocardiogram findings with arrhythmia prevalence.
- To determine the diagnostic yield of Holter monitoring based on specific hypertensive cardiac changes.
Summary:
- 88 hypertensive patients underwent ECG, echocardiogram, and 24-hour Holter monitoring.
- Patients with normal ECGs showed minimal arrhythmias, not requiring Holter monitoring.
- ST-T wave changes on ECG indicated high-grade ventricular arrhythmias in 75% of patients.
- Echocardiography identified left ventricular hypertrophy (LVH); significant LVH (septal thickness ≥12 mm) correlated with high-grade arrhythmias in 65% of cases, warranting Holter monitoring.
Impact:
- Provides clear criteria for utilizing Holter monitoring in hypertensive individuals.
- Optimizes diagnostic resource allocation by identifying low-risk patient groups.
- Enhances early detection of potentially serious ventricular arrhythmias in hypertension management.
Abstract:
The aim of the present study was to determine when a search for ventricular arrhythmias, by ambulatory electrocardiographic monitoring, is necessary in hypertensive patients. An electrocardiogram, an echocardiogram and a 24 hour Holter monitoring were recorded in 88 patients with essential hypertension. According to the results of electrocardiogram patients were subdivided into 4 groups: normal electrocardiogram, isolated left auricular hypertrophy (LAH), isolated left ventricular hypertrophy (LVH) and major ST-T wave changes. According to the degree of septal thickness (ST), patients were classed in 4 groups. [table; see text] For hypertensive patients with normal electrocardiogram, Holter monitoring is not necessary; in fact practically no complex arrhythmias is found in this group. On the contrary, for hypertensive subjects with ST-T waves changes, this investigation seems very interesting, nearly 75% of them present high-grade ventricular arrhythmias. For the patients with electrocardiographic isolated LAH or LVH, the realisation of an echocardiography permits to separate the subjects with mild LVH (ST less than 12 mm) where Holter monitoring is not necessary (81% Lown O-I) and the patients with mean or severe LVH (ST greater than or equal to 12 mm) where this investigation seems very interesting, nearly 65% of them present high-grade ventricular arrhythmias.