Circulation, Vol 75, 395-400, Copyright © 1987 by American Heart Association
MB Rocco, J Barry, S Campbell, E Nabel, EF Cook, L Goldman and AP Selwyn
To examine whether a significant circadian variation of transient
myocardial ischemia exists and to better understand the character of such
variation, 32 patients with chronic stable symptoms of coronary artery
disease underwent one or more days of ambulatory monitoring of ischemic ST
segment changes during daily life. A total of 251 episodes of ischemic ST
segment depression occurred in 24 (75%) of the 32 patients with a median
duration of 5 min (range 1 to 253). A significant circadian increase in
ischemic activity was found with 39% of episodes and 46% of total ischemic
time occurring between 6 A.M. and 12 P.M. (p less than .05 and p = .02,
respectively). In 21 patients with ST segment depression during the 6 hr
after waking and the 6 hr before sleep, 68% of episodes occurred in the
morning compared with 32% in the evening. There were no significant
differences in heart rate at onset, heart rate at 1 min before onset, and
activity score associated with ST segment depression. The proportion of
minutes showing ST segment depression when the heart rate was above the
lowest rate associated with ST segment depression was significantly greater
in the morning compared with the evening (26% vs 15%; p = .03). Thus the
early morning increase in ST segment depression does not appear to be
explained by differences in extrinsic activity and/or stress measured by
physical activity score and heart rate response. More importantly, this
phenomenon is often ignored by the usual patterns of drug administration
for angina.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Circadian variation of transient myocardial ischemia in patients with coronary artery disease
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