Open AccessPersistent painless st‐segment depression after exercise testing and the effect of age
Author(s) -
Flugelman M. Y.,
Halon D. A.,
Shefer A.,
Peer M.,
Dagan T.,
Lewis B. S.,
Schneeweiss A.
Publication year - 1988
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960110602
Subject(s) - medicine , angina , depression (economics) , st segment , st depression , chest pain , treadmill , cardiology , ischemia , metabolic equivalent , pathological , physical therapy , anesthesia , physical activity , myocardial infarction , economics , macroeconomics
The relation between the duration of ischemic ST‐segment depression (1 mm or more 60 ms after the J point) and the clinical awareness of chest pain was studied in 31 patients (aged 39–73 years) undergoing symptom‐limited, graded treadmill exercise testing. The response of these patients to nitrate therapy (spray or sublingual tablet) given immediately on cessation of exercise was also studied. During exercise, angina pectoris appeared at an estimated workload of 4.6±2.2 metabolic equivalents (METS) (mean±SD), and pathological ST‐segment depression at 4.9 ± 1.9 METS (p=NS.) On cessation of exercise, angina disappeared after 3.0±1.9 min, but ST‐segment depression persisted for more than twice as long (6.6 ± 4.1 min) (p < 0.0001). The ratio of time to ST‐segment recovery/time to relief of pain (a quantitative measure of silent ischemia during recovery) increased with age (r = 0.49, p = 0.002), and in 16 patients over 60 years of age was higher than in 15 younger patients (3.6 ± 2.5 vs. 2.1 ± 1.4) (p < 0.04). The silent ischemia ratio after exercise tended to decrease, although not significantly so (p = 0.2), in patients who received oral nitrates; there was no difference in the response to spray or tablet in this regard. We conclude that ST‐segment depression frequently persists after relief of exercise‐induced angina pectoris and more so in elderly patients.