Silent Myocardial Ischemia During Holter Monitoring in Ischemic Heart Disease : PANEL DISCUSSION ON SILENT MYOCARDIAL ISCHEMIA
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概要
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The purpose of this study was to investigate the frequency and characteristics of silent myocardial ischemia in patients with proven ischemic heart disease using ambulatory ECG monitoring, and to clarify possible mechanisms for the absence of symptoms during these attacks. A total of 182 patients, including 78 patients with stable effort angina (EA), 12 with unstable angina (UA), and 92 with prior myocardial infarction (MI), were examined. During daily activities, 43% and 56% of all transient ST-segment depression observed was asymptomatic in patients with EA and MI, respectively. In addition, 74% of all ischemic episodes were asymptomatic in patients with UA. In patients with EA, 35% exhibited both symptomatic and asymptomatic attacks, and the duration and magnitude of ST-segment depression were greater for symptomatic attacks than for asymptomatic attacks. On the other hand, in patients with MI, 55% had only asymptomatic attacks. When asymptomatic episodes in patients who had only asymptomatic attacks were compared with symptomatic episodes in patients who had only symptomatic attacks, asymptomatic episodes tended to be associated with a greater magnitude of ST depression. They were also significantly longer in duration than the symptomatic episodes. All patients with UA had both symptomatic and asymptomatic episodes, and the magnitude and duration were significantly greater during the former. These results lead us to conclude that: (1) silent myocardial ischemia is observed frequently in patients with EA and MI during daily activities. In particular, patients with MI tend to have more severe silent ischemia. (2) In patients with EA and UA, the severity of ischemia is a fundamental factor in determining the presence or absence of pain during an ischemic attack. (3) In patients with MI, the occurrence of silent myocardial ischemia probably depends upon alteration in the pain threshold or perception.
- 社団法人日本循環器学会の論文
- 1989-11-20
著者
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SUZUKI Yoshiyuki
Department of Radiation Oncology, Gunma University Graduate school of Medicine
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Kohya Tetsuro
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Tomita Fumishi
Department of Cardiovascular Medicine, Hokkaido University, Graduate School of Medicine
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YASUDA HISAKAZU
Department of Cardiovascular Medicine, Hokkaido University School of Medicine
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Yasuda Hisakazu
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine Sapporo Japan
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Yasuda Hisakazu
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Yasuda Hisakazu
Department Of Cardiology Hokkaido University School Of Medicine Sapporo
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Itoh Kazusuke
Department of Cardiovascular Medicine, Hokkaido University School of Medicne
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KAWABATA Noriko
Department of Cardiovascular Medicine, Hokkaido University School of Medicine
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Suzuki Yoshiyuki
Department Of Hepatology Toranomon Hospital
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Ito Kazusuke
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine Sapporo
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Kohya Tetsuro
Department Of Cardiovascular Medicine Hokkaido University Graduate School Of Medicine
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Kohya Tetsuro
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Kohya Tetsuro
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine Sapporo
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Yasuda Hisakazu
The Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Itoh Kazusuke
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Itoh Kazusuke
Department Of Cardiology Natinal Hospital Organization Hakodate Hospital
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Tomita Fumishi
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Tomita Fumishi
Department Of Cardiovascular Medicine Hokkaido University Graduate School Of Medicine
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ANDOH JOHJI
Department of Cardiovascular Medicine, Hokkaido University School of Medicine
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Andoh Johji
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Yasuda Hisakazu
Department Of Cardiology Hokkaido University School Of Medicine
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Suzuki Yoshiyuki
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Suzuki Yoshiyuki
Department Of Applied Physics Tohoku University
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Kawabata Noriko
Department Of Cardiovascular Medicine Hokkaido University School Of Medicine
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Kawabata Noriko
Department Of Cardiology School Of Medicine Hokkaido University
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Yasuda Hisakazu
Department O F Cardiovascular Medicine Hokkaido University School Of Medicine
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