[Echocardiographic assessment of segmental kinetic changes of the left ventricle during ischemic attacks induced by...

The detection of stress-induced wall motion abnormalities by means of 2D Echo represents a reliable marker of ischemia. Few reports about two-dimensional echocardiography and provocative tests in patients suffering from primary angina are available in the literature. Twenty patients with electrocardiographically documented ischemic transitory attacks at rest underwent hyperventilation test 2-15 days after a spontaneous episode. A new wall motion abnormality and/or a worsening of an asynergy already present at rest occurred in ten patients; eight of them also showed diagnostic ECG changes. Wall motion abnormalities arose significantly earlier (from the end of hyperventilation: 1.7 +/- .84 vs 2.16 +/- 1.15 min, p less than .05). Three patients had angina, which, in all patients started after echocardiographic and ECG changes. All patients experienced paresthesia, and two patients tinnitus due to blood alkalosis. No clinical adverse reaction resulted from the test. Only one patient had ventricular arrhythmias in the recovery phase of the ischemia.

As concerns hyperventilation test, echocardiography has proven useful in identifying myocardial ischemia, comparable to electrocardiography. Moreover, in this study some patients had echocardiographic but not electrocardiographic changes as ischemic manifestations. Events after induction of ischemia with hyperventilation seem to follow the same sequence already observed in spontaneous attacks.