Ambulatory (Holter) electrocardiography and myocardial ischemia

Kennedy, Harold L.; Wiens, Robert D.

doi:10.1016/0002-8703(89)90672-8

Cited by 39 publications

(14 citation statements)

References 113 publications

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“…CONCLUSIONS -Out-of-hospital ambulatory Holter monitoring of STsegment abnormalities in patients with CAD has shown that most ischemic events occur during activities of daily living (12). Patients with CAD and diabetes have more episodes of silent ischemia than patients without diabetes (19).…”

Section: Discussionmentioning

confidence: 95%

“…However, these were not in ambulatory patients with known CAD and were not specific for cardiac ischemia (10,11) With the availability of a continuous glucose sensor, combined with continuous ECG monitoring, new technologies make it possible to examine relationships between hypoglycemia and cardiac ischemia (12,13). We therefore conducted this study to determine the feasibility of simultaneous monitoring of ECG and blood glucose and to determine whether an association exists between changes in the two parameters…”

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confidence: 99%

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Association of Hypoglycemia and Cardiac Ischemia

et al. 2003

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OBJECTIVE -In some studies intensive diabetes treatment in patients with type 2 diabetes may be associated with increased cardiovascular events. It is not clear whether these events are related to hypoglycemic episodes. To determine whether episodes of hypoglycemia were more likely to be associated with cardiac ischemia than normoglycemia or hyperglycemia, we carried out a study in 21 patients with coronary artery disease (CAD) and type 2 diabetes treated with insulin who had good glycemic control.RESEARCH DESIGN AND METHODS -We carried out 72-h continuous glucose monitoring along with simultaneous cardiac Holter monitoring for ischemia. Patients also recorded symptoms of cardiac ischemia (chest pain) and symptoms of hypoglycemia.RESULTS -Satisfactory continuous glucose monitoring system recordings were obtained in 19 patients. We recorded 54 episodes of hypoglycemia (blood glucose Ͻ70 mg/dl; 26 of these were symptomatic) and 59 episodes of hyperglycemia (blood glucose Ͼ200 mg/dl; none symptomatic). Of the 54 episodes of hypoglycemia, 10 were associated with symptoms of chest pain, during 4 of which electrocardiographic abnormalities were documented. In contrast, only 1 episode of chest pain occurred during 59 episodes of hyperglycemia. No chest pain or electrocardiographic abnormalities occurred when the blood glucose was within the normal range. The difference between the frequency of ischemia during hypoglycemia and the frequency during both hyperglycemia and normoglycemia was statistically significant (P Ͻ 0.01). There were 50 episodes during which the blood glucose changed by Ͼ100 mg over a 60-min period, and ischemic symptoms occurred during 9 of these episodes (P Ͻ 0.01 compared with stable normoglycemia or hyperglycemia).CONCLUSIONS -Hypoglycemia is more likely to be associated with cardiac ischemia and symptoms than normoglycemia and hyperglycemia, and it is particularly common in patients who experience considerable swings in blood glucose. These data may be important in the institution of insulin treatment and attempting near-normal glycemia in patients with known CAD. Further research is needed to determine strategies to prevent ischemia associated with hypoglycemia. Diabetes Care 26:1485-1489, 2003D iabetes is associated with an increased risk of development of coronary artery disease (CAD). Patients with CAD and diabetes have higher mortality and morbidity than patients without diabetes. Data from studies such as the U.K. Prospective Diabetes Study suggest that very good glycemic control is associated with fewer cardiovascular events (1). However, tight glycemic control may increase the risk of hypoglycemia. Increased cardiovascular events were noted in the Veterans Affairs Cooperative Study on Glycemic Control and Complications (VA CSDM), after the institution of tight glycemic control (2). It is possible that acute hypoglycemia may trigger ischemia and cardiovascular events. Hypoglycemia and rapid changes in blood glucose have been shown to increase counterregulatory hormones such as epinephrine ...

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Association of Hypoglycemia and Cardiac Ischemia

et al. 2003

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“…The Holter recording was considered positive for silent myocardial is chemia when there was elevation or depression o f the S-T segment >0.1 mV 80 ms after the J point on the ECG. An absolute require ment was that both the duration o f the S -T elevation or depression and the interval between successive episodes be > 6 0 sec [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Painless Myocardial Ischemia in Chronic Hemodialysed Patients: A Real Event?

Kremastinos¹,

Paraskevaidis²,

Voudiklari³

et al. 1992

Nephron

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We investigated the incidence of painless (silent) myocardial ischemia, manifested as S-T segment deviation, by Holier ECG monitoring in patients with chronic renal failure undergoing regular hemodialysis. Forty-five patients underwent Holier ECG monitoring for a continuous 48-hour period covering dialysis and the intermediate period of everyday activity at home. ECG criteria for ischemia were found in 15.5% of patients mainly during and immediately after dialysis with a simultaneous increase of R, S, R+ S amplitude. There was no correlation of S-T segment deviation with the existence of cardiac dysfunction and coronary artery disease proved by hemodynamic and angiographic studies. It is concluded that hemodialysis itself seems to play an important role in the genesis of the above ECG findings, possibly by means of serum K and Mg changes.

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“…With both the 9-lead DCG and the 12-lead ECG. ischemic ST changes were defined as positive when they persisted for at least I min and met one of the following criteria: (1) horizon tal or downsloping ST depression of 0.1 mV or greater at 80 ms after the ST junction [1]: (2) ST elevation of 0.2 mV or greater at 80 ms after the ST junction.…”

Section: Clinical Applicationmentioning

confidence: 99%

“…With a 2-or 3-lead Holter mon itor. on the other hand, the frequency and duration of myocardial ischemia occurring during daily activities can be determined [1], but the extent of ischemia cannot be assessed because of the limited number of leads. This method may also fail to detect right coronary artery disease [2] or miss ischemic ST changes that are shown by leads I and aVL of the 12-lead ECG [3], because the recording sites are restricted to the anterior wall.…”

Section: Introductionmentioning

confidence: 99%

Correlation of Coronary Artery Stenosis Site with Anterior or Inferior Projection of ST Changes Induced by Treadmill Exercise Using a Newly Devised 9-Lead Holter Method

Tanabe

Yoshioka²,

Takahasi³

et al. 1992

Cardiology

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A 9-lead Holter monitor using the lead-switching technique (9-lead DCG) and conventional 12-lead electrocardiograph (12-lead ECG) were simultaneously used for recording during treadmill exercise testing (Td-test) in 140 patients with coronary artery disease. Coronary arteriography was performed in 118 of the 140 patients, and the correlation between coronary stenosis and anterior or inferior projection of ST depressions occurring during the Td-test was investigated. Additionally, 10 patients with acute myocardial infarction (AMI) were studied to test ST elevation detection by the 9-lead DCG. The CM5 lead demonstrated ST depressions in 92 of the 109 patients showing ST depressions in one or more leads. High lateral (HL) and/or low lateral leads detected all ST depressions occurring in the I and aVL leads of the 12-lead ECG. Leads CM1, CM2 and CM3 exhibited low sensitivity (0-32%) and high specificity (56-100%), while leads CM4, CM5, and CM6 provided greater sensitivity (66-95%), but less specificity (3-32%) in detecting diseases of the left anterior descending artery, left circumflex artery and/or right coronary artery (RCA). In contrast, the low back (LB) lead demonstrated high sensitivity (88%) and high specificity (86%) in detecting RCA disease. Lead CM3 detected ST elevations in all 6 patients with anterior AMI, while the LB lead did so in all 4 patients with inferior AMI. With a Holter monitor, 4 leads are needed: CM5 like, CM3 like, lateral (such as HL) and inferior (such as LB). The LB lead is useful in detecting inferior ischemia.

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Ambulatory (Holter) electrocardiography and myocardial ischemia

Cited by 39 publications

References 113 publications

Association of Hypoglycemia and Cardiac Ischemia

Association of Hypoglycemia and Cardiac Ischemia

Painless Myocardial Ischemia in Chronic Hemodialysed Patients: A Real Event?

Correlation of Coronary Artery Stenosis Site with Anterior or Inferior Projection of ST Changes Induced by Treadmill Exercise Using a Newly Devised 9-Lead Holter Method

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