Asymptomatic myocardial ischemia in patients with stable and typical angina pectoris

Abstract

Summary:The existence of transient niyocardial ischemia (TMI) and the value of the serial dynamic electrocardiogram (DCG) in patients with variant or unstable angina pectoris are known. However, less information is available on the frequency and characteristics of TMI in patients with stable angina pectoris. For this study, we selected 40 patients with stable and typical angina pectoris. The presence of coronary artery disease and the ejection fraction were evaluated by means of angiocardiography. The DCG monitoring was performed with bichannel portable recorders for three 24-h periods at 7-day intervals. The patients were on optimal doses of beta blockers and isosorbidilate throughout the study.We detected 788 episodes of TMI in 22 of the 40 patients. The ejection fraction was poorer in the 22 patients with ST-Tchanges than in the 18 without such changes. The repolarization changes were: ( I ) ST elevation (55 symptomatic and 87 asymptomatic episodes, (2) ST depression ( 1 38 symptomatic and 236 asymptomatic episodes. and (3) T-wave changes (83 symptomatic and 164 asymptomatic episodes). All 22 patients with TMI prcsented a combination of the above changes. It appears, therefore, that ST-T changes are more frequent in patients with stable angina pectoris than was hitherto suspected. The DCG is valuable in assessing these

Treatment of Angina Pectoris in General Practice with a Combination of Nifedipine and Beta‐B locker

“…The findings that the decreases in nitrate consumption and attack frequency at 8 and 12 weeks after introducing nifedipine were greater than those noted after 4 weeks suggest either that the efficacy of the combination therapy increased with repeated administration or that, as the study continued, there was a gradual increase in patient compliance. With nifedipine monotherapy, there is evidence that the antianginal effect of the drug only reaches a maximum between 4 and 6 weeks after commencing treatment (Cocco et al , 1979). Whether or not the present results reflect a true increase in drug efficacy, they confirm that repeated administration of nifedipine does not result in tachyphylaxis (Ebner and Dunschede, 1976; Menna et al , 1976).…”

Biobehavioral factors in sudden cardiac death.

“…These studies suggest that ambulatory myocardial ischemia, uncommon for normal people, occurs with some frequency in patients with significant coronary disease (Selwyn et al, 1986). The majority of everyday ischemic episodes are “silent” or asymptomatic, even among patients who report frequent chest pain (Barry et al, 1988; Cocco et al, 1982; Schang & Pepine, 1977; Selwyn et al, 1986; Stern et al, 1988).…”