This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Araki, H. Articles by Nakamura, M. Search for Related Content PubMed PubMed Citation Articles by Araki, H. Articles by Nakamura, M.

Circulation, Vol 67, 995-1000, Copyright © 1983 by American Heart Association

ARTICLES

Diurnal distribution of ST-segment elevation and related arrhythmias in patients with variant angina: a study by ambulatory ECG monitoring

H Araki, Y Koiwaya, O Nakagaki and M Nakamura

Twenty-four-hour ambulatory ECG recording was performed in 26 patients with variant angina to evaluate the diurnal distribution of ST-segment elevation in relation to chest pain and the incidence of arrhythmias during the episodes. During a recording period of 52 days, 364 ST- segment elevations of 1 mm or greater were observed and 79% were asymptomatic. ST-segment elevation frequently occurred between 0:00 and 9:00 hours (72%) and most frequently between 5:00 and 6:00 hours (13%). Only a few episodes occurred between 10:00 and 18:00 hours. Premature atrial contractions, premature ventricular contractions (PVCs), ventricular tachycardia (VT) and complete atrioventricular block occurred during 12% of the episodes and were more common during painful episodes (32%) than during painless ones (6%). However, VT and severe forms of PVCs (couplets and bigeminy) appeared eight times during painless episodes and nine times during painful ones. Arrhythmias occurred more frequently when the elevated ST segment started to return or was returning to the control level (n = 38) than when the ST segment was rising (n = 8). The incidence of arrhythmias was lower when the daily frequency of ischemic episodes was high. This study shows that episodes of asymptomatic coronary artery spasm predominantly occur early in the morning as symptomatic episodes; complex dysrhythmias appear during the asymptomatic episodes; arrhythmias occur predominantly during a "reperfusion period;" and more arrhythmias accompany infrequent daily episodes of ischemia than frequent ones.

This article has been cited by other articles:

				B.J. Drew, M.M. Pelter, and M.G. Adams Frequency, characteristics, and clinical significance of transient ST segment elevation in patients with acute coronary syndromes Eur. Heart J., June 2, 2002; 23(12): 941 - 947. [Abstract] [Full Text] [PDF]

				A. L. Wit and M. J. Janse Reperfusion Arrhythmias and Sudden Cardiac Death: A Century of Progress Toward an Understanding of the Mechanisms Circ. Res., October 26, 2001; 89(9): 741 - 743. [Full Text] [PDF]

				E. L. Kanabrocki, R. B. Sothern, H. L. Messmore, B. Roitman-Johnson, J. B. McCormick, S. Dawson, F. W. Bremner, J. L. H. C. Third, B. A. Nemchausky, P. Shirazi, et al. Circadian Interrelationships Among Levels of Plasma Fibrinogen, Blood Platelets, and Serum Interleukin-6 Clinical and Applied Thrombosis/Hemostasis, January 1, 1999; 5(1): 37 - 42. [Abstract] [PDF]

				J. Figueras and R. M. Lidon Early Morning Reduction in Ischemic Threshold in Patients With Unstable Angina and Significant Coronary Disease Circulation, October 1, 1995; 92(7): 1737 - 1742. [Abstract] [Full Text]