TY - JOUR
T1 - Triggers of angina and ST-segment depression in ambulatory patients with coronary artery disease
T2 - Evidence for an uncoupling of angina and ischemia
AU - Krantz, David S.
AU - Hedges, Susan M.
AU - Gabbay, Frances H.
AU - Klein, Jacob
AU - Falconer, Jennifer J.
AU - Merz, C. Noel Bairey
AU - Gottdiener, John S.
AU - Lutz, Helene
AU - Rozanski, Alan
N1 - Funding Information:
Prom the *Department of Medical Psychology, Uniformed sity of the Health Sciences, Bethesda; the bCardiology Sinai Medical Center, Los Angeles; the %ardiology TJniversity Medical Center, Washington; the dDivision Luke’s Roosevelt Medical Center, New York. Supported by grants from the John D. and Catherine T. MacArthur Foundation, from the National Institutes of Health (HL47337), and from the $Jniformed Services University of the Health Sciences (RO7233). The opinions and assertions herein are those of the authors and are not to he construed as reflecting the views of the Uniformed Services University of the Health Sciences or the United States Department of Defense. for publication July 29, 1993; accepted Jan. 6, 1994. Reprint requests: David S. Krantz, PhD, Department of Medical ogy, Uniformed Services University of the Health Sciences, Bridge Road, Bethesda, MD 20814-4799. 111157066
PY - 1994/10
Y1 - 1994/10
N2 - This study evaluated daily-life physical and mental triggers of painful and painless myocardial ischemia and of anginal pain in patients with coronary artery disease (CAD) by using ambulatory electrocardiographic monitoring and a structured diary. Eighty-five percent of ambulant ischemic episodes occurred without chest pain; 66% of anginal pain reports were made in the absence of ischemic ST-segment depression. Chest pain reports in the absence of ischemia could not be attributed to "borderline" ST-segment changes. Compared with silent ischemia, painful ischemia was triggered at higher levels of physical activity (p < 0.05) and at higher levels of self-rated effort and negative emotion (p < 0.05). Painful episodes were associated with greater-magnitude ST depression (p < 0.02), but a substantial percentage of episodes with ≥2 mm and ≥3 mm ST depression were silent. These results reveal an uncoupling of anginal symptoms from ambulatory ischemic episodes in patients with CAD during daily life. In addition, specific activities and emotions correlate with the presence or absence of anginal symptoms as much as does the presence of ischemic ST depression. These results may have implications for antiischemic and antianginal treatment strategies.
AB - This study evaluated daily-life physical and mental triggers of painful and painless myocardial ischemia and of anginal pain in patients with coronary artery disease (CAD) by using ambulatory electrocardiographic monitoring and a structured diary. Eighty-five percent of ambulant ischemic episodes occurred without chest pain; 66% of anginal pain reports were made in the absence of ischemic ST-segment depression. Chest pain reports in the absence of ischemia could not be attributed to "borderline" ST-segment changes. Compared with silent ischemia, painful ischemia was triggered at higher levels of physical activity (p < 0.05) and at higher levels of self-rated effort and negative emotion (p < 0.05). Painful episodes were associated with greater-magnitude ST depression (p < 0.02), but a substantial percentage of episodes with ≥2 mm and ≥3 mm ST depression were silent. These results reveal an uncoupling of anginal symptoms from ambulatory ischemic episodes in patients with CAD during daily life. In addition, specific activities and emotions correlate with the presence or absence of anginal symptoms as much as does the presence of ischemic ST depression. These results may have implications for antiischemic and antianginal treatment strategies.
UR - https://www.scopus.com/pages/publications/0028019639
U2 - 10.1016/0002-8703(94)90268-2
DO - 10.1016/0002-8703(94)90268-2
M3 - Article
C2 - 7942441
AN - SCOPUS:0028019639
SN - 0002-8703
VL - 128
SP - 703
EP - 712
JO - American Heart Journal
JF - American Heart Journal
IS - 4
ER -