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[Myocardial ischemia induced by the cold pressor test in patients with exertion angina. Case contribution]
Insights
The cold pressor test rarely causes myocardial ischemia in stable angina patients. Ischemia during cold stimulation is more likely in those with severe coronary artery disease and prior heart attacks.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Testing
Context:
- Stable exertional angina pectoris is a common condition.
- The cold pressor test (CPT) is used to assess cardiovascular autonomic function.
- The relationship between cold exposure and angina symptoms requires further investigation.
Purpose:
- To evaluate the occurrence of myocardial ischemia during the cold pressor test in patients with stable exertional angina pectoris.
- To determine if CPT can reliably induce ischemic changes in this patient group.
Summary:
- Thirty-seven patients with coronary artery disease underwent CPT and exercise stress testing with electrocardiogram monitoring.
- Electrocardiographic signs of subendocardial ischemia were observed in only 3 patients during CPT.
- These patients had previous myocardial infarction, low exercise tolerance, and severe coronary lesions (triple vessel or left main disease).
Impact:
- CPT is an uncommon trigger for electrocardiographic ischemia in stable angina patients.
- Ischemia during CPT is more probable in patients with significant coronary artery disease.
- Further research needs more sensitive ischemia markers or modified cold application methods to study cold exposure and angina.
Abstract:
The aim of the present study was to assess the incidence of myocardial ischemia during cold pressor test in patients with stable exertional angina pectoris. Thirty-seven patients with proven coronary artery disease were submitted to cold pressor and exercise stress testing; computer assisted electrocardiographic recordings were obtained throughout the examinations. Cold stimulation provoked electrocardiographic signs of subendocardial ischemia only in 3 patients. They had suffered of a previous myocardial infarction and showed low exercise tolerance and severe coronary lesions (one with triple vessel and 2 with left main disease). Interestingly, only one of these patients gave an history of angina during cold exposure. Thus these data indicate that chest pain and electrocardiographic signs of ischemia are an uncommon event during cold pressor stimulation which occurs more likely in patients with fairly severe coronary narrowings. More sensitive markers of ischemia and/or different modalities of cold application are required for studies concerning the relationship between cold exposure and angina pectoris.