This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kleinfeld, M. J. Articles by Rozanski, J. J. Search for Related Content PubMed PubMed Citation Articles by Kleinfeld, M. J. Articles by Rozanski, J. J.

Circulation, Vol 55, 574-577, Copyright © 1977 by American Heart Association

ARTICLES

Alternans of the ST segment in Prinzmetal's angina

MJ Kleinfeld and JJ Rozanski

Alternans of the elevated ST segment (STEA) was found in 8 of 21 patients (38%) with Prinzmetal's variant angina. In addition to STEA, all eight patients had varying cardiac arrhythmias: multiple premature ventricular depolarizations in eight, ventricular tachycardia in five, and ventricular fibrillation in three. There was no consistent temporal relationship between the occurrence of STEA and the cardiac arrhythmias. Alternans occurred during periods when no arrhythmias were present. All eight patients underwent coronary angiography. Spontaneous coronary artery spasm was documented angiographically in three patients including two who had minimal or no coronary atherosclerotic disease. Six patients had severe, fixed, occlusive coronary artery disease. Possible mechanisms for STEA include: 1) failure of regions of myocardium to depolarize on alternate beats due to variation in conduction and refractoriness between ischemic and nonischemic zones of myocardium, and 2) electrical alternans of the transmembrane action potential during phase 2 and 3 (repolarization) caused by changes in the rate and extent of electrolyte transfer across cell membranes during ischemia. It is postulated that STEA is an electrocardiographic sign in the surface ECG of a dysequilibrium of refractory periods during ischemia and reflects an unstable electrical state of the myocardium.

This article has been cited by other articles:

				M. P. Slawnych, T. Nieminen, M. Kahonen, K. M. Kavanagh, T. Lehtimaki, D. Ramadan, J. Viik, S. G. Aggarwal, R. Lehtinen, L. Ellis, et al. Post-exercise assessment of cardiac repolarization alternans in patients with coronary artery disease using the modified moving average method. J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1130 - 1137. [Abstract] [Full Text] [PDF]

				F. G. Cosío, J.#x. Palacios, A.#x.;n Pastor, and A. Núñez CHAPTER 2 The Electrocardiogram ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				S. M. Narayan T-Wave Alternans and the Susceptibility to Ventricular Arrhythmias J. Am. Coll. Cardiol., January 17, 2006; 47(2): 269 - 281. [Abstract] [Full Text] [PDF]

				M. L Walker and D. S Rosenbaum Repolarization alternans: implications for the mechanism and prevention of sudden cardiac death Cardiovasc Res, March 1, 2003; 57(3): 599 - 614. [Abstract] [Full Text] [PDF]

				J. Castro Hevia, F. Dorticos Balea, M. Dorantes Sánchez, R. Zayas Molina, and M. A. Quiñones Pérez Unusual response to the ajmaline test in a patient with Brugada syndrome Europace, January 1, 2003; 5(4): 371 - 373. [Abstract] [Full Text] [PDF]

				A. A. Armoundas, G. F. Tomaselli, and H. D. Esperer Pathophysiological basis and clinical application of T-wave alternans J. Am. Coll. Cardiol., July 17, 2002; 40(2): 207 - 217. [Abstract] [Full Text] [PDF]

				H. V. Barron T-wave alternans and serious ventricular arrhythmias: a tale of two T-waves J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2254 - 2256. [Full Text] [PDF]

				E. S. Kaufman, J. A. Mackall, B. Julka, C. Drabek, and D. S. Rosenbaum Influence of heart rate and sympathetic stimulation on arrhythmogenic T wave alternans Am J Physiol Heart Circ Physiol, September 1, 2000; 279(3): H1248 - H1255. [Abstract] [Full Text] [PDF]

				J.-M. Cao, Z. Qu, Y.-H. Kim, T.-J. Wu, A. Garfinkel, J. N. Weiss, H. S. Karagueuzian, and P.-S. Chen Spatiotemporal Heterogeneity in the Induction of Ventricular Fibrillation by Rapid Pacing : Importance of Cardiac Restitution Properties Circ. Res., June 11, 1999; 84(11): 1318 - 1331. [Abstract] [Full Text] [PDF]

				T. Kwan, A. Feit, M. Alam, E. Afflu, L. T. Clark, and T. Kwan ST-T Alternans and Myocardial Ischemia Angiology, March 1, 1999; 50(3): 217 - 222. [Abstract] [PDF]

				D. S. Rosenbaum, L. E. Jackson, J. M. Smith, H. Garan, J. N. Ruskin, and R. J. Cohen Electrical Alternans and Vulnerability to Ventricular Arrhythmias N. Engl. J. Med., January 27, 1994; 330(4): 235 - 241. [Abstract] [Full Text]

				S. Okamoto, M. Inden, T. Konishi, and T. Nakano ST Segment Alternans During Percutaneous Transluminal Coronary Angioplasty A Case Report Angiology, January 1, 1991; 42(1): 30 - 34. [Abstract] [PDF]

				V. Chockalingam, V. Jaganathan, P. V. Chandrasekar, A. Sankaran, and C. Lakshmikanthan A Case of ST-Segment and T-Wave Alternans Arch Intern Med, September 1, 1983; 143(9): 1792 - 1792. [Abstract] [PDF]

				N. Belie and J. M. Gardin ECG Manifestations of Myocardial Ischemia Arch Intern Med, September 1, 1980; 140(9): 1162 - 1165. [Abstract] [PDF]

				R. J. LUCHI, R. A. CHAHINE, and A. E. RAIZNER Coronary Artery Spasm Ann Intern Med, September 1, 1979; 91(3): 441 - 449. [Abstract] [PDF]

				J. J. ROZANSKI, J. MELLER, M. KLEINFELD, A. CASTELLANOS, and J. KUPERSMITH Nonmechanical ST-Segment Alternans in Prinzmetal's Angina Ann Intern Med, July 1, 1978; 89(1): 76 - 77. [Abstract] [PDF]