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[Painless myocardial ischemia in patients with stable stenocardia]
Insights
Silent myocardial ischemia, characterized by painless ST-segment depression, is common in stable angina. Its frequency and severity correlate with coronary artery disease extent and exercise intensity.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- Stable angina pectoris is a common cardiovascular condition.
- Myocardial ischemia, often presenting with chest pain, can also occur silently.
Purpose of the Study:
- To investigate the prevalence and characteristics of silent myocardial ischemia in patients with stable angina.
- To evaluate the antianginal effects of finoptin and obsidan in this patient group.
Main Methods:
- 24-hour Holter monitoring was conducted on 58 patients with stable angina.
- Coronary angiography and bicycle ergometry were used to assess disease severity and exercise tolerance.
- Antianginal effects of finoptin and obsidan were evaluated through Holter monitoring and ergometric tests.
Main Results:
- 70.7% of patients experienced painless ischemic ST-segment depression episodes, comprising 45.7% of all ischemic events.
- Silent ischemia episodes were shorter during physical activity and longer at rest.
- Increased coronary vessel disease and higher exercise loads (≥100 Wt) correlated with more frequent and severe silent ischemia.
- Obsidan's antianginal effect diminished after 2 months of therapy.
- Finoptin was ineffective in 46.2% of patients, despite improved exercise tolerance.
Conclusions:
- Silent myocardial ischemia is a significant component of ischemia in stable angina patients.
- The characteristics and frequency of silent ischemia are influenced by disease severity and physical exertion.
- Obsidan shows a transient effect, while finoptin demonstrates limited efficacy in managing stable angina.
Abstract:
24-hour Holter monitoring was performed in 58 patients with stable angina pectoris. Out of them, 70.7% were recorded to have painless ischemic ST-segment depression episodes which made up some half (45.7%) of the total number of myocardial ischemic episodes. The episodes of silent myocardial ischemia were characterized by various length, depending on the conditions of their occurrence. They were far short-term with physical activity and long-term at rest. An increase in the number of diseased coronary vessels in the patients undergoing coronary angiography was followed by a rise in the amount of episodes and ST-segment displacement amplitude. In patients who had an bicycle ergometric loading of 100 Wt or greater, the episodes of silent myocardial ischemia were observed twice more frequently than in patients who had a threshold loading of 25 to 50 Wt. Some proportion of the patients exhibited variations in the Holter monitoring and paired bicycle ergometric tests when finoptin and obsidan were evaluated for their antianginal effect. There was a significant decrease in obsidan's effect following 2-month continuous therapy. Despite the persistent growth of exercise tolerance as evidenced by bicycle ergometry, finoptin proved to be inefficient in 46.2% of the patients.