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S-T segment elevation and coronary spasm in response to exercise

B R Chaitman, D D Waters, P Théroux

    The American Journal of Cardiology
    |June 1, 1981
    PubMed
    Summary

    Exercise-induced ST segment elevation in symptomatic patients indicates severe myocardial ischemia and often suggests coronary artery stenosis. Its causes vary, particularly in post-infarction, variant angina, and other patient groups.

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    Area of Science:

    • Cardiology
    • Exercise Physiology
    • Diagnostic Electrocardiography

    Background:

    • Exercise-induced ST segment elevation (SI) in symptomatic individuals occurs in 3.0–6.5% of cases.
    • ST elevation signifies more severe myocardial ischemia than depression, often indicating significant coronary artery stenosis.
    • Specific ECG leads (V4-V6, CM5) show limited sensitivity for detecting exercise-induced ST elevation.

    Purpose of the Study:

    • To review the prevalence and pathogenesis of exercise-induced ST segment elevation in symptomatic patients.
    • To differentiate the mechanisms of ST elevation across distinct clinical subgroups.
    • To highlight the diagnostic implications of ST elevation in various cardiac conditions.

    Main Methods:

    • Review of existing literature on exercise-induced ST segment elevation.

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  • Analysis of prevalence rates and electrocardiographic findings in symptomatic patients.
  • Categorization of patients into three subsets: post-myocardial infarction, variant angina, and others without infarction or variant angina.

    • Main Results:

    • In post-infarction patients, ST elevation often appears in leads with Q waves, linked to anterior myocardial infarction and abnormal wall motion.
    • In variant angina, 10–30% exhibit exercise-induced ST elevation, likely due to coronary artery spasm.
    • In patients without infarction or variant angina (0.2–1.7%), ST elevation is associated with high-grade coronary stenoses, though pathogenesis is not fully elucidated.

    Conclusions:

    • Exercise-induced ST segment elevation has varied pathogenesis across different patient populations.
    • It is a marker of significant myocardial ischemia and coronary artery disease.
    • Further research is needed to fully understand the mechanisms in patients without infarction or variant angina.