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[Silent ischemia in long-term ECG in the early post-infarct period]
M Nürnberg1, B Biber, M Buchelt
13. Medizinische Abteilung Ludwig Boltzmann-Institut für Arrhythmieforschung, Wilhelminenspital, Wien.
Insights
Silent ischemia is common after myocardial infarction, often occurring without exercise and showing a circadian pattern. Automatic ST-segment analysis requires visual verification for clinical use.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Context:
- Assessing post-transmural infarction patients.
- Utilizing 24-hour Holter monitoring in the third week post-infarction.
Purpose:
- To investigate the occurrence and characteristics of silent ischemic episodes.
- To evaluate the circadian rhythm of ischemic events.
- To determine the correlation between ischemia and ventricular arrhythmia.
- To assess the clinical utility of automatic ST-segment analysis.
Summary:
- 101 patients under 70 with recent transmural infarction underwent Holter monitoring.
- 20% experienced ischemic episodes, predominantly silent (95%) and often unrelated to exercise.
- Ischemia exhibited a circadian pattern, peaking between 6-12 AM.
- No correlation was found between ischemia and ventricular arrhythmia.
- Visual control of automated ST-segment analysis is crucial for clinical application.
Impact:
- Highlights the prevalence of silent ischemia in post-myocardial infarction patients.
- Reveals a circadian predisposition to ischemic events.
- Underscores the need for careful interpretation of automated ST-segment analysis in clinical practice.
Abstract:
101 consecutive patients (73 m, 29 f; 48 AMI, 53 IMI) under 70 years were assigned to 24 hour-Holter monitoring in the third week after first transmural infarction. ST-segment analysis could be performed in 88 patients (89%). 18 patients (20%) had episodes of ischemia which were silent in 95%. One third of these episodes occurred in the absence of physical exercise. Ischemic events displayed a circadian rhythm with a maximum between 6 and 12 a.m. There was no correlation between ischemia and the occurrence of ventricular arrhythmia. In addition, we show that visual control of automatic ST-segment analysis is a prerequisite for routine use in clinical practice.