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[Incidence of painless ischemic heart disease]
M Negrusz-Kawecka1, J Moszczyńska-Stulin
1Katedry i Kliniki Kardiologii AM we Wrocławiu.
Insights
Most myocardial ischemia episodes in stable angina patients are silent. Painless ischemic attacks were longer and associated with slower heart rates than painful ones, indicating silent ischemia is a significant concern in coronary artery disease management.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Context:
- Stable exercise angina pectoris and history of myocardial infarction are common cardiovascular conditions.
- 24-hour Holter monitoring is a standard diagnostic tool for assessing cardiac ischemia.
- Identifying characteristics of ischemic episodes is crucial for patient management.
Purpose:
- To analyze and compare the characteristics of symptomatic (anginal pain) versus asymptomatic (painless) ischemic episodes detected by 24-hour Holter monitoring in patients with stable angina and prior myocardial infarction.
Summary:
- 130 patients with stable angina and myocardial infarction history underwent 24-hour ECG monitoring.
- 69% of 237 detected ischemic episodes were painless.
- Painless ischemic attacks were longer and occurred at slower heart rates compared to episodes with anginal pain; ST segment changes were similar.
Impact:
- Highlights the prevalence of silent myocardial ischemia in this patient population.
- Suggests that painless ischemic episodes may represent a significant burden of ischemia.
- Informs clinical practice regarding the comprehensive assessment of ischemic heart disease beyond symptomatic presentation.
Abstract:
A 24-hour ECG monitoring was carried out in 130 patients with stable exercise angina pectoris and history of myocardial infarction. A diagnosis of ischemic heart disease was based on anamnesis, positive result of exercise test and dipyridamole test, and the result of coronary angiography in some patients. Patients with unchanged repolarization period in ECG were classified to the study. Electrocardiogram was registered with Holter technique in patients performing their usual activities. Recorded ECG was analysed with visual technique in Medilog 3000 system. Two hundred thirty seven ischemic episodes were shown in the examined patients, including 69% of painless ischemic attacks and 31% of ischemic attacks with anginal pain. Duration of painless ischemic attacks with anginal pain. Duration of painless ischemic attacks was longer, heart rate slower, and ST segment elevation did not differ in both types of myocardial ischemia.