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Changes in myocardial ischemic threshold during daily activities.

S Banai1, M Moriel, J Benhorin

  • 1Heiden Department of Cardiology, Bikur Cholim Hospital, Jerusalem, Israel.

The American Journal of Cardiology
|December 15, 1990
PubMed
Summary
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Myocardial ischemic threshold varies significantly during daily life in coronary artery disease patients. This variability, linked to heart rate changes, may indicate coronary artery vasomotor activity.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Physiology

Background:

  • Coronary artery disease (CAD) management often relies on understanding myocardial ischemic thresholds.
  • Ischemic episodes in CAD patients can occur during various daily activities, not just exertion.
  • Holter monitoring provides continuous electrocardiogram (ECG) data to detect these episodes.

Purpose of the Study:

  • To assess the variability of myocardial ischemic threshold during daily activities.
  • To correlate heart rate changes preceding ischemic episodes with the ischemic threshold.
  • To explore the relationship between ischemic threshold variability and the frequency of ischemic events.

Main Methods:

  • Studied 80 patients with known CAD and documented ischemic episodes on Holter monitoring.

Related Experiment Videos

  • Determined the lowest and highest heart rate at the onset of ischemia for each patient.
  • Analyzed 895 ischemic episodes to identify preceding heart rate changes.

    • Main Results:

    • Mean lowest ischemic threshold was 85 beats/min; mean highest was 109 beats/min.
    • Highest ischemic threshold matched values observed during exercise stress tests.
    • 74% of ischemic episodes were preceded by a >10% heart rate increase.
    • Ischemic threshold variability increased with the number of ischemic episodes (2-60%).

    Conclusions:

    • Significant variability exists in myocardial ischemic thresholds during daily activities in CAD patients.
    • Heart rate increases often precede ischemic episodes, even during non-exertional activities.
    • Ischemic threshold variability may serve as an indirect indicator of coronary artery vasomotor function.