Usefulness of a third holter lead for detection of myocardial ischemia

Lanza, Gaetano Antonio; Mascellanti, Marco; Placentino, Marisa; Lucente, Michele; Crea, Filippo; Maseri, Attilio

doi:10.1016/0002-9149(94)90551-7

Cited by 21 publications

(10 citation statements)

References 21 publications

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“…Simultaneously, median ST-segment level was lower during and immediately after exercise than at first rest. ST-segment depression was rare in the modified aVF lead, and all subsequent analyses are based on findings in the modified V5 lead, the lead that most consistently identifies myocardial ischemia when it is present (Lanza et al 1994). Air pollution levels were only modestly elevated, and maximum levels for U.S. EPA criteria pollutants were all below accepted or proposed National Air Quality Standards (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Air Pollution and ST-Segment Depression in Elderly Subjects

Gold

Litonjua

Zanobetti

et al. 2005

Environ Health Perspect

113

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Increased levels of daily ambient particle pollution have been associated with increased risk of cardiovascular morbidity. Black carbon (BC) is a measure of the traffic-related component of particles. We investigated associations between ambient pollution and ST-segment levels in a repeated-measures study including 269 observations on 24 active Boston residents 61–88 years of age, each observed up to 12 times from June through September 1999. The protocol involved continuous Holter electrocardiogram monitoring including 5 min of rest, 5 min of standing, 5 min of exercise outdoors, 5 min of recovery, and 20 cycles of paced breathing. Pollution-associated ST-depression was estimated for a 10th- to 90th-percentile change in BC. We calculated the average ST-segment level, referenced to the P-R isoelectric values, for each portion of the protocol. The mean BC level in the previous 12 hr, and the BC level 5 hr before testing, predicted ST-segment depression in most portions of the protocol, but the effect was strongest in the postexercise periods. During post-exercise rest, an elevated BC level was associated with −0.1 mm ST-segment depression (p = 0.02 for 12-hr mean BC; p = 0.001 for 5-hr BC) in continuous models. Elevated BC also predicted increased risk of ST-segment depression ≥0.5 mm among those with at least one episode of that level of ST-segment depression. Carbon monoxide was not a confounder of this association. ST-segment depression, possibly representing myocardial ischemia or inflammation, is associated with increased exposure to particles whose predominant source is traffic.

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Section: Resultsmentioning

confidence: 99%

Air Pollution and ST-Segment Depression in Elderly Subjects

Gold

Litonjua

Zanobetti

et al. 2005

Environ Health Perspect

113

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“…The lead that detects abnormalities of the ST segment of the ECG most accurately is CM 5 . 20,21 ST segment depressions of 1 mm (0.1 mV), starting 60 ms after the J-point and lasting for a minimum of 1 minute, were considered significant if horizontal or downward sloping. 22 The ECG recording was commenced before presentation to the operating theatre and continued for 2 hours postoperatively.…”

Section: Methodsmentioning

confidence: 99%

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Jonsson

Hanson

Lidell

et al. 2009

BJOG

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Objective To investigate whether there is a difference in occurrence of electrocardiogram changes suggestive of myocardial ischaemia between two different doses of oxytocin.Design Double-blind randomised controlled trial Setting University hospital in Sweden.Population A total of 103 healthy women undergoing elective caesarean section under spinal anaesthesia.Methods The participants were randomised to 5 or 10 units of oxytocin, given as an intravenous bolus. A Holter monitor was used to record electrocardiograms and non invasive blood pressure and heart rate (HR) was monitored. A blood sample was obtained 12-hour postoperatively.Main outcome measures Depression of the ST segment. Secondary outcomes: symptoms, Troponon I levels, mean arterial pressure (MAP), HR and blood loss.Results There was a significant difference in occurrence of ST depressions associated with oxytocin administration, 4 (7.7%) with 5 and 11 (21.6%) with 10 units, P < 0.05. The absolute risk reduction was 13.9% (95% confidence interval, 0.5-27.3). Decrease of mean MAP from baseline to 2 minutes differed, being 9 mmHg in the 5 unit group and 17 mmHg in the 10 unit group (P < 0.01). The increase in mean HR did not differ. Troponin I levels were increased in four subjects (3.9%). There were no differences in occurrence of symptoms, Troponin I levels, or estimated blood loss.Conclusion ST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 units compared with 5 units. Interventions to prevent hypotension during caesarean section may reduce the occurrence of ST depressions on electrocardiograms.

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“…It seems likely that in this patient the choice of the monitoring lead of the electrocardiogram was inappropriate and did not represent the positive site of spasm-associated ischaemia. Therefore, in such patients multiple electrocardiographic leads, representing both the anterior and inferior/posterior wall of the heart, are necessary [28] . Despite the low prevalence of coronary artery spasm in our study, we believe that for optimal diagnostic work-up, an ergonovine provocation test should be performed in all patients with ventricular fibrillation and non-apparent cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

Low prevalence of coronary artery spasm in patients with normal coronary angiograms and unexplained ventricular fibrillation

Peters

Wever

Hauer

et al. 1998

European Heart Journal

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AimsThe aetiology of ventricular fibrillation in patients without identifiable structural heart disease is unknown. Recently, a high prevalence of silent ischaemia due to coronary artery spasm has been reported in such patients. However, in at least one report, all patients had non-critical coronary artery lesions. Identification of coronary artery spasm as the underlying aetiology of ventricular fibrillation has important therapeutic implications. Methods and ResultsWe performed ergonovine provocation tests in 18 patients (14 males, and four females; mean age, 36 years) with documented ventricular fibrillation in the absence of identifiable structural heart disease who had undergone aborted sudden death. In group I (n=7) ergonovine provocation tests were performed at a mean interval of 31 months (range 21-42 months) after the index episode. These patients had already received an implantable cardioverter defibrillator, after failed electrophysiologically guided antiarrhythmic therapy. In group II (n=11) the ergonovine provocation test was performed prospectively as part of the diagnostic evaluation. All patients were off antiarrhythmic drugs, calcium entry or beta-adrenoceptor blockers at the time of the ergonovine provocation test. Ergonovine was administered intravenously as a bolus injection, beginning with 0·05 mg followed every 3 min by incremental doses up to a cumulative maximum dose of 0·45 mg. Predefined end-points were: (1) recording of ischaemic ST segment shifts of d1 mm in at least two corresponding leads of the 12-lead electrocardiogram; (2) induction of ventricular tachycardia or ventricular fibrillation; and (3) administration of a cumulative dose of 0·45 mg. A positive response to ergonovine was seen in only one patient (5%) in group I in whom there developed ST segment elevation without angina and a short burst of rapid ventricular tachycardia.Conclusions This study found a low prevalence of coronary artery spasm in patients with aborted sudden death resulting from documented ventricular fibrillation and non-apparent underlying heart disease. All patients had normal coronary angiograms and a negative history for spontaneous episodes of chest pain. The mechanism of arrhythmogenesis in such patients remains largely unknown.

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Usefulness of a third holter lead for detection of myocardial ischemia

Cited by 21 publications

References 21 publications

Air Pollution and ST-Segment Depression in Elderly Subjects

Air Pollution and ST-Segment Depression in Elderly Subjects

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Low prevalence of coronary artery spasm in patients with normal coronary angiograms and unexplained ventricular fibrillation

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