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Persistent painless ST-segment depression after exercise testing and the effect of age
M Y Flugelman1, D A Halon, A Shefer
1Department of Cardiology, Lady Davis Carmel Hospital, Haifa, Israel.
Clinical Cardiology
|June 1, 1988
Summary
Silent ischemia, indicated by ST-segment depression, often continues after chest pain relief in patients undergoing exercise tests. This silent ischemia is more pronounced in older individuals.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Exercise stress testing is crucial for diagnosing cardiac ischemia.
- Chest pain (angina pectoris) is a common symptom, but silent ischemia can occur.
- Understanding the duration and characteristics of ischemic ST-segment depression is vital.
Purpose of the Study:
- To investigate the relationship between the duration of ischemic ST-segment depression and the clinical awareness of chest pain.
- To assess the impact of nitrate therapy on silent ischemia following exercise.
Main Methods:
- 31 patients (39-73 years) underwent symptom-limited graded treadmill exercise testing.
- ST-segment depression (≥1 mm, 60 ms post-J point) and angina pectoris were monitored.
- Nitrate therapy (spray or sublingual) was administered post-exercise.
Main Results:
- Angina resolved in 3.0 ± 1.9 min, while ST-segment depression persisted for 6.6 ± 4.1 min (p<0.0001).
- The ratio of ST-segment recovery time to pain relief time increased with age (r=0.49, p=0.002).
- Elderly patients (>60 years) showed a higher silent ischemia ratio compared to younger patients.
Conclusions:
- ST-segment depression frequently outlasts angina relief after exercise, indicating persistent myocardial ischemia.
- Silent ischemia during recovery is more prevalent in older individuals.
- Nitrate therapy showed a non-significant trend towards decreasing the silent ischemia ratio.