Evaluation of chest pain by holter monitoring in patients of hypertrophic cardiomyopathy
Keywords:Hypertrophic Cardiomyopathy, Chest pain, Dyspnea, ST-segment, Myocardial ischemia
Background: Patients with hypertrophic cardiomyopathy frequently complain of pain chest during daily activities even despite normal resting ECG and normal coronary angiogram. It seems to be related to myocardial ischemia which may lead to progressive left ventricular remodeling and fibrosis. These morphological changes may produce intractable symptoms and life threatening arrhythmia. The aim of the study is to evaluate the chest pain and clinical significance of ST-segment depression during daily normal activities in the patients with hypertrophic Cardiomyopathy as a noninvasive marker of ischemia.
Methods: Continuous 48 hours Holter monitoring was perform in 106 patients aged (40 ±12 years) with hypertrophic Cardiomyopathy. 92 patients’ (86%) Holter recording were suitable for ST-segment analysis.
Results: A total of 97 episodes of ST-segment depression (>1 mm from baseline) were recorded in 26 patients (Male 21, Female 5). In patients < 30 years of age (but not > 30 years) were correlated between ST-segment desperation and history of exertional chest pain (9 of 15 vs 1 of 21, P- 0011) and dyspnea NYHA II/III ( 9 of 14 vs 1 of 22 P-004). There was no correlation between ST-segment depression and risk factors for sudden death, such as family history of sudden death, sustained and non sustained ventricular tachycardia and history of syncope.
Conclusions: In Holter monitoring ST-segment depression is common in younger patients with history of typical pain chest of cardiac origin and dyspnea.
McKenna WJ, Deanfield J, Faruqui A, England D, Oakley C, Goodwin J. Prognosis in hypertrophic cardiomyopathy. Role of age and clinical, electrocardiographic and hemodynamic features. Am J Cardiol. 1981;47;532-8.
.Dissmann R, Schultheiss HP. Ischaemia in patients with hypertrophic cardiomyopathy-various causes and symptoms and the difficulties of ischaemia screening tests. Eur Heart J. 1996;17(7):982-4.
Stafford WJ, Trohman RG, Bilsker M, Zaman L,Castellanos A, Myerburg RJ. Cardiac arrest in an adolescent with atrial fibrillation and hypertrophic cardiopathy. J Am CollCardiol. 1986;7:701-4.
Nicod P, Polikar R, Peterson KL. Hypertrophic cardiomyopathy and sudden death. N Engl J Med. 1988;318:1255-7.
Pasternac A, Noble J, Streulens Y, ElieR, Henschke C,Bourassa MG. Pathophysiology of chest pain in patient with cardiomyopathies and normal coronary arteriograms. Circulation. 1982;65:778-89.
Elliott PM, Kaski JC, Prasad K, Seo H, Slade AK, Goldman JH, et al. Chest pain during daily life in patients with hypertrophic myopathy:an ambulatory electrocardiographic study. Eur Heart J. 1996;17:1056-64.
Deanfield JE, Shea M, Ribiero P, de Landsheere CM, Wilson RA, Horlock P, et al. Transient ST-segment depression as a marker of myocardial ischaemia during daily life. Am J Cardiol. 1984;54:1195-200.
Weissler AM, Weiss JL. Exercise stress testing. Circulation. 1977;56:699-713.
Rifkin DR, Hood WB Bayesian analysis of electrocardiographic exercise stress testing. N Engl J Med 1977; 297: 681-6.
Stern S, Tazivoni D. Early detection of silent ischaemic heart disease by 24 hour electrocardiographic monitoring of active subjects. Br Heart J. 1974;36:481-6.
Crake T, Crean PA, Shapiro LM, Rickards AF, Poole-Wilson PA. Coronary sinus PH during percutaneous transluminal angioplasty; early development of acidosis during myocardial ischaemia in man. Br Heart J. 1987;58:110-5.
Hanrath P, Montz R, Mathey D, Thiel U, Vorbringer H, Kupper W, et al. Correlation between myocardial thallium-201 kinetics, myocardial lactate metabolism and coronary angiographic findings in hypertrophic cardiomyopathy. Zeitschrift fur kardiologie. 1980;69:353-9.
Cannon RO, Dilsizian V, O'Gara PT, Udelson JE, Schenke WH, Quyyumi A, et al. Myocardial metabolic, hemodynamic and electrocardiographic significance of reversible thallium -201 abnormalities in hypertrophic cardiomyopathy. Circulation. 1991;83:1660-7.
Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG. Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteriograms. Circulation. 1982;65:778-89.
Satfford WJ, Trohman RG, Bilsker M, Zaman L, Castellanos A, Myerbug RJ. Cardiac arrest in an adolescent with atrial fibrillation and hypertrophic cardiomyopathy. J Am Coll Cardiol. 1986;7:701-4.
DilsizianV, Bonow RO, Epstein SE, Fananapazir L. Myocardial ischaemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1993:22:796-804.
Mckenna WJ, Camm AJ. Sudden death in hypertrophic cardiomyopathy: Assessment of patients at high risk. Circulation. 1989;80:1489-92.
Frenneaux MP, Counihan PJ, Porter A, Lipkin DP, Mckenna WJ. Effects of amiodarone on erect and supine exercise haemodynamics and exercise capacity in patients with hypertrophic cardiomyopathy. Eur Heart J. 1992;13:687-96.
Camici P, Marraccini P, Lorenzoni R et al. Metabolic markers of stress induced myocardial ischaemia. Circulation. 1991;83:III8-13.
Camici P, Chiriatti G, Lorenzoni R et al. Coronary vasodilatation is impaired in both hypertrophied and non hypertrophied myocardium of patients with hypertrophic cardiomyopathy: A study with Nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol. 1991;17:879-86.
Shimonagata T, Nishimura T, Uehara T et al. Discrepancies between myocardial perfusion and free fatty acid metabolism in patients with hypertrophic cardiomyopathy. Nuclear Medicine Communications. 1993;14:1005-13.