The Effect of Hyperventilation on the Normal Adult Electrocardiogram

Wasserburger, Richard H.; Siebecker, Karl L.; Lewis, William C.; Lloyd, C. Janet

doi:10.1161/01.cir.13.6.850

Cited by 68 publications

(17 citation statements)

References 8 publications

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“…Indeed there should be certain clinical correlations to the appearance of T-wave changes during coronary vasospasm.24) We think it inadequate to include them in the positive criteria because hyperventilation often induces similar ECG findings in normals. 25,26) In agreement with the study of Weber et al,8) no serious complications related to the hyperventilation test occurred in this study. Only 2 patients developed short runs of ventricular premature contractions, but these disappeared before sublingual administration of nitroglycerin.…”

Section: Discussionsupporting

confidence: 93%

Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

et al. 1995

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SUMMARYTo establish a safe and sensitive diagnostic procedure for detecting coronary vasospasm, we utilized 201-thallium myocardial SPECT combined with hyperventilation (HV-SPECT) in 29 patients with vasospastic angina (VAP) and 11 controls.Twenty-five of 29 patients with VAP and 5 of 11 controls developed transient perfusion defects on HV-SPECT, resulting in a sensitivity and specificity calculated at 86% and 55%, respectively.Overall accuracy in identifying corresponding vessels with coronary vasospasm was 67%; it was 83%, 75% and 42% for patients with 1, 2 and 3 vessel spasm, respectively. Coronary vasospasm tended to be identified more accurately in the left anterior descending branch and the right coronary artery than in the circumflex branch (75%, 71% and 50%, respectively).The hyperventilation test induced ischemic ECG changes in 11 of 29 patients with VAP, yielding a sensitivity of 38%. Analyzing the washout rate of HV-SPECT in patients with VAP, both the extent and severity scores of patients with ischemic ECG changes were larger than those of patients without. No serious complications occurred during HV-SPECT.In conclusion, HV-SPECT was a safe and sensitive procedure as a primary diagnostic approach for VAR From the results of washout analysis, HV-SPECT could detect more mild myocardial ischemia than could the ECG, and seemed quite useful especially for detecting coronary vasospasm accompanied by minimal ischemic ECG changes. (Jpn Heart J 36: 405-420, 1995)

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Section: Discussionsupporting

confidence: 93%

Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

et al. 1995

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“…Hypocapnia caused this reduction, because it was absent during mechanical hyperventilation in normocapnia. This contrasts with the ECG changes seen during voluntary hyperventilation, which were sometimes abolished by 5% CO 2 (5,8,16,60) and sometimes not (6,16,49,58,60). Furthermore, our reduction was detected after 10 min of hypocapnia, whereas measurements during voluntary hyperventilation are sometimes made after only 60 s or less and without Pa CO 2 measurement (22,26,31,58).…”

Section: Ajp-regul Integr Comp Physiolcontrasting

confidence: 79%

“…Furthermore, our reduction was detected after 10 min of hypocapnia, whereas measurements during voluntary hyperventilation are sometimes made after only 60 s or less and without Pa CO 2 measurement (22,26,31,58). This reduction occurred in 13 of 15 normal subjects and is therefore much more reproducible than any effect during voluntary hyperventilation (16,20,22,58).…”

Section: Ajp-regul Integr Comp Physiolmentioning

confidence: 71%

“…This is because numerous studies in healthy subjects report that hypocapnia produces only inconsistent decreases in the amplitude of the ECG T wave that are not reproducible in every subject (5,6,8,16,20,22,30,49,54,58).…”

mentioning

confidence: 99%

“…These difficulties are compounded by the lack of a standardized procedure for ECG analysis during hyperventilation. It is unclear precisely how many ECG complexes were measured, how they were selected, and what was their precise relationship to the inflation cycle (6,16,58,60).…”

mentioning

confidence: 99%

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Hypocapnia reduces the T wave of the electrocardiogram in normal human subjects

Rutherford¹,

Clutton-Brock²,

Parkes³

2005

American Journal of Physiology-Regulatory, Integrative and Comp

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During voluntary hyperventilation in unanesthetized humans, hypocapnia causes coronary vasoconstriction and decreased oxygen (O 2) supply and availability to the heart. This can induce local epicardial coronary artery spasm in susceptible patients. Its diagnostic potential for detection of early heart disease is unclear. This is because such hypocapnia produces an inconsistent and irreproducible effect on electrocardiogram (ECG) in healthy subjects. To resolve this inconsistency, we have applied two new experimental techniques in normal, healthy subjects to measure the effects of hypocapnia on their ECG: mechanical hyperventilation and averaging of multiple ECG cycles. In 15 normal subjects, we show that hypocapnia (20 Ϯ 1 mmHg) significantly reduced mean T wave amplitude by 0.1 Ϯ 0.0 mV. Hypocapnia also increased mean heart rate by 4 beats/min without significantly altering blood pressure, ionized calcium or potassium levels, or the R wave or other features of the ECG. We therefore provide the first unequivocal demonstration that hypocapnia does consistently reduce T wave amplitude in normal, healthy subjects. coronary circulation; carbon dioxide; angina DURING VOLUNTARY HYPERVENTILATION in unanesthetized humans, hypocapnia causes coronary vasoconstriction and decreased oxygen (O 2 ) supply and availability to the heart. Thus cardiac catheterization studies show that voluntary hyperventilation [to partial pressure levels of carbon dioxide in arterial blood (Pa CO 2 ) of 20 mmHg] increases coronary vascular resistance by 17% (47), decreases coronary blood flow by 30% (47), and increases the affinity of hemoglobin for O 2 by 25% (35). During voluntary hyperventilation, hypocapnia can induce local epicardial coronary artery spasm in single or multiple vessels with associated ST displacement, both in susceptible patients with voluntary hyperventilation syndrome (but without symptoms of heart disease) (15, 24) and in the rare group of patients with Prinzmetal's variant angina (29,59).It is unclear whether this effect has any diagnostic potential for early coronary heart disease. This is because numerous studies in healthy subjects report that hypocapnia produces only inconsistent decreases in the amplitude of the ECG T wave that are not reproducible in every subject (5,6,8,16,20,22,30,49,54,58).Such inconsistency is not surprising because of the methodological difficulties inherent with voluntary hyperventilation in the variability of inflation volumes achieved and of the duration, level, and stability of hypocapnia. Variability in movement of the body surface (and its attached electrodes) relative to the heart with each inflation introduces a crucial artifact that alone might explain this inconsistency. These difficulties are compounded by the lack of a standardized procedure for ECG analysis during hyperventilation. It is unclear precisely how many ECG complexes were measured, how they were selected, and what was their precise relationship to the inflation cycle (6,16,58,60).We have therefore applied two novel ap...

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Hyperventilation Syndrome

Yu¹

1959

AMA Arch Intern Med

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The Effect of Hyperventilation on the Normal Adult Electrocardiogram

Cited by 68 publications

References 8 publications

Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

Hypocapnia reduces the T wave of the electrocardiogram in normal human subjects

Hyperventilation Syndrome

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