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Neurohumoral Regulation in Silent Myocardial Ischemia

  • Chapter
Neurohumoral Regulation of Coronary Flow

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 150))

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Abstract

Ambulatory monitoring of the electrocardiogram has revealed the occurrence of transient myocardial ischemia in a substantial number of patients with coronary artery disease. As was noted by Stern and Tzivoni in 19741 the majority of these transient ST segment changes are not accompanied by symptoms of chest pain, which phenomenon became known as silent ischemia. In a study of 210 patients referred for evaluation of coronary artery disease Tzivoni and coworkers found that 46% of these patients had transient myocardial ischemia17. In 150 patients with ischemic heart disease not receiving medical therapy Mulcahy et al registrated transient myocardial ischemia in 61% of the patients; of all episodes with significant ST segment changes 75% were asymptomatic. They observed however that frequent occurrence of silent ischemia was limited to a small number of patients: 50% of all episodes occurred in only 7% of all patients18. Other studies in patients with stable angina pectoris receiving standard medical therapy showed episodes of also predominantly silent myocardial ischemia in 40 to 50% of all patients19,20.

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References

  1. Stern S, Tzivoni D. Early detection of silent ischemic heart disease by 24 hour electrocardiographical monitoring of active subjects. Br Heart J 1974;36:481.

    Article  PubMed  CAS  Google Scholar 

  2. Maseri A. Variant angina and coronary vasospasm. Clues to a broader understanding of angina pectoris. Cardiovasc Med 1979;4:647.

    Google Scholar 

  3. Maseri A, Chierchia S, Kaski JC. Mixed angina pectoris. Am J Cardiol 1985;56:31E

    Article  Google Scholar 

  4. Vatner SF. Regulation of coronary resistance vessels and large coronary arteries. Am J Cardiol 1985;56:16E.

    Article  PubMed  CAS  Google Scholar 

  5. Braunwald E, Sobel BE. Coronary blood flow and myocardial ischemia. In: Braunwald, E ed. Heart disease, a textbook of cardiovascular medicine (3th ed.). Philadelphia: WB Saunders 1988;1191.

    Google Scholar 

  6. Young MA, Vatner SF. Regulation of large coronary arteries. Circ Res 1986;59:579.

    Article  PubMed  CAS  Google Scholar 

  7. Cox DA, Hintze TH, Vatner SF. Effects of acetylcholine on large and small coronary arteries in conscious dogs. J Pharmacol Exp Ther 1983;225:764.

    PubMed  CAS  Google Scholar 

  8. Furchgott RF, Zawadski JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980;288:373.

    Article  PubMed  CAS  Google Scholar 

  9. Furchgott RF. Role of endothelium in responses of vascular smooth muscle. Circ Res 1983;53:557.

    Article  PubMed  CAS  Google Scholar 

  10. Peach MJ, Loeb AL, Singer HA, Saye J. Endothelium-derived vascular relaxing factor. Hypertension 7 1985;(Suppl.1):l–94.

    Google Scholar 

  11. Pohl U, Holtz J, Busse R, Bassenge E. Crucial role of endothelium in the vasodilator response to increased flow in vivo. Hypertension 1986;8:37.

    Article  PubMed  CAS  Google Scholar 

  12. Rubanyi GM, Romero JC, Vanhoutte PM. Flow-induced release of endothelium derived relaxing factor. Am J Physiol 1986;250:H1145.

    PubMed  CAS  Google Scholar 

  13. Föstermann U, Mügge A, Alheid U, Haverich A, Frölich JC. Selective attenuation of endothelium-mediatedvasodilatation in atherosclerotic human coronary arteries. Circ Res 1988;62:185.

    Article  Google Scholar 

  14. Girerd XJ, Hirsch AT, Cooke JP, Dzau VJ, Creager MA. L-Arginine augments endothelium-dependent vasodilatation in cholesterol-fed rabbits. Circ Res 1990;67:1301.

    Article  PubMed  CAS  Google Scholar 

  15. Ludmer PL, Selwym AP, Shook TL, et al. Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med 1986;315:1046.

    Article  PubMed  CAS  Google Scholar 

  16. Griffith TM, Edwards DH, Collins P, Lewis MJ, Henders AH. Endothelium-derived relaxant factor. J Royal Coll Phys Lond 1983;19:74.

    Google Scholar 

  17. Tzivoni D, Gavish A, Benhorin J, et al. Myocardial ischemia during daily activities and stress. Am J Cardiol 1986;58:47B.

    Article  PubMed  CAS  Google Scholar 

  18. Mulcahy D, Keegan J, Crean P, et al. Silent myocardial ischemia in chronic stable angina: a study of its frequency and characteristics in 150 patients. Br Heart J 1988;60:417.

    Article  PubMed  CAS  Google Scholar 

  19. Weidinger F, Sochor H, Pospischil E, et al. Characteristics of transient ischemic episodes in patients with silent and symptomatic exercise-induced myocardial ischemia. Eur Heart J 1988;9:1081.

    PubMed  CAS  Google Scholar 

  20. Mulcahy D, Keegan J, Lindsay D, et al. Silent myocardial ischemia in patients referred for coronary artery bypass surgery because of angina: a comparison with patients whose symptoms were well controlled on medical treatment. Br Heart J 1989;61:496.

    Article  PubMed  CAS  Google Scholar 

  21. Rocco MB, Nabel EG, Campbell S, et al. Prognostic importance of myocardial ischemia detected by ambulatory monitoring in patients with stable angina. Circulation 1988;78:877.

    Article  PubMed  CAS  Google Scholar 

  22. Deedwania PC, Carbajal EV. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation 1990:81:748.

    Article  PubMed  CAS  Google Scholar 

  23. Fox KM, Mulcahy D. Therapeutic rationale for the management of silent ischemia. Circulation 1990 (suppl 11);82:155.

    Google Scholar 

  24. Schang SJ, Pepine CJ. Transient asymptomatic ST segment depression during daily activity. Am J Cardiol 1977;39:396.

    Article  PubMed  Google Scholar 

  25. Deanfield JE, Maseri A, Selwyn AP, et al. Myocardial ischemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes. Lancet 1983;ll:753.

    Article  Google Scholar 

  26. Checchi AC, Dovellini EV, Marchi F, et al. Silent myocardial ischemia during ambulatory electrocardiographic monitoring in patients with effort angina. J Am Coll Cardiol 1983;1:934.

    Article  Google Scholar 

  27. Cohn PF, Laws WE. Characteristics of silent myocardial ischemia during out-of-hospital activities in asymptomatic angiographically documented coronary artery disease. Am J Cardiol 1987;59:746.

    Article  PubMed  CAS  Google Scholar 

  28. Chierchia S, Gallino A, Smith G, et al. Role of heart rate in pathophysiology of chronic stable angina. Lancet 1984;1:1353.

    Article  Google Scholar 

  29. Deanfield JE, Shea M, Kensett M, et al. Silent myocardial ischemia due to mental stress. Lancet 1984;ll:1001.

    Article  Google Scholar 

  30. Deanfield JE, Shea M, Ribiero P, et al. Transient ST segment depression as a marker of myocardial ischemia during daily life. Am J Cardiol 1984;54:1195.

    Article  PubMed  CAS  Google Scholar 

  31. Rozanski A, Bairy CN, Krantz DS, et al. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Engl J Med 1988;318:1005.

    Article  PubMed  CAS  Google Scholar 

  32. Dimsdale JE, Moss J. Plasma catecholamines in stress and exercise. JAMA 1980;243:340.

    Article  PubMed  CAS  Google Scholar 

  33. Rebecca G, Wagner R, Zebede T, et al. Pathogenetic mechanisms causing transient myocardial ischemia with mental arousal in patients with coronary artery disease. Clin Res 1986;34:338A (abstract).

    Google Scholar 

  34. Deanfield JE, Shea MJ, Wils RA, et al. Direct effects of smoking on the heart: silent ischemic disturbances of coronary flow. Am J Cardiol 1986;57:1005.

    Article  PubMed  CAS  Google Scholar 

  35. Turton MB, Deegan T. Circadian variations of plasma catecholamine, cortisol and immunoreactive insulin concentrations in supine subjects. Clin Chim Acta 1974;55:389.

    Article  PubMed  CAS  Google Scholar 

  36. Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of blood pressure. Lancet 1978;l:795.

    Article  Google Scholar 

  37. Rocco MB, Berry J, Campbell S, et al. Circadian variation of transient myocardial ischemia in patients with coronary artery disease. Circulation 1987;75:395.

    Article  PubMed  CAS  Google Scholar 

  38. Mulcahy D, Keegan J, Cunningham D, et al. Circadian variation of total ischemic burden and its alteration with anti-anginal agents. Lancet 1988;ll:755.

    Article  Google Scholar 

  39. Quyyumi AA, Panza JA, Lakatos E, et al. Circadian variation in ischemic events: causal role of variation in ischemic threshold due to changes in vascular resistance. Circulation 1988;78:ll–331 (suppl 2, abstract).

    Google Scholar 

  40. Deedwania PC, Nelson JR. Pathophysiology of silent myocardial ischemia during daily life. Hemodynamic evaluation by simultaneous electrocardiographic and blood pressure monitoring. Circulation 1990;82:1296.

    Article  PubMed  CAS  Google Scholar 

  41. Willich SN, Levy D, Rocco MB, et al. Circadian variation in the incidence of sudden cardiac death in the Framingham heart study population. Am J Cardiol 1987;60:801.

    Article  PubMed  CAS  Google Scholar 

  42. Muller JE, Ste PH, Turi ZG, et al. Circadian variation in the frequency of set of acute myocardial infarction. N Engl J Med 1985;313:1315.

    Article  PubMed  CAS  Google Scholar 

  43. Muller JE, Ludmer PL, Willich SN, et al. Circadian variations in the frequency of sudden cardiac death. Circulation 1987;75:131.

    Article  PubMed  CAS  Google Scholar 

  44. Hjalmarson A, Gilpin EA, Nicod P, et al. Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction. Circulation 1989;80:267.

    Article  PubMed  CAS  Google Scholar 

  45. Tofler GH, Brezinski D, Schafer Al, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden death. N Engl J Med 1987;514.

    Google Scholar 

  46. Furlan R, Guzzetti S, Crivellaro W, et al.Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects. Circulation 1990;7.

    Google Scholar 

  47. Kleiger RE, Miller JP, Bigger JT, et al.Decreased heart rate variability and its association with increased mortality after myocardial infarction. Am J Cardiol 1987;6.

    Google Scholar 

  48. Bigger JT, Kleiger RE, Fleiss JL, et al: Components of heart rate variability measured during healing of acute myocardial infarction. Am J Cardiol 1988;8.

    Google Scholar 

  49. Rich MW, Saini JS, Kleiger RE, et al. Correlation of heart rate variability with clinical and angiographic variables and late mortality after coronary angiography. Am J Cardiol 1989;6.

    Google Scholar 

  50. Fujita M, Franklin D. Diurnal changes in coronary blood flow in conscious dogs. Circulation 1987;76:488.

    Article  PubMed  CAS  Google Scholar 

  51. Assey ME, Walters Gl, Hendrix GH, et al. Incidence of acute myocardial infarction in patients with exercise-induced silent myocardial ischemia. Am J Cardiol 1987;59:497.

    Article  PubMed  CAS  Google Scholar 

  52. Sharma B, Asinger R, Francis GS, et al. Demonstration of exercise-induced painless myocardial ischemia in survivors of out-of-hospital ventricular fibrillation. Am J Cardiol 1987;59:740.

    Article  PubMed  CAS  Google Scholar 

  53. Imperi GA, Lambert CR, Coy K, et al. Effects of titrated beta blockade (metoprolol) on silent myocardial ischemia in ambulatory patients with coronary artery disease. Am J Cardiol 1987;60:519.

    Article  PubMed  CAS  Google Scholar 

  54. Angleton P, Chandler WL, Schmer G. Diurnal variation of tissue-type plasminogen activator and its rapid inhibitor (PAI-1). Circulation 1989;79:101.

    Article  PubMed  CAS  Google Scholar 

  55. Verrier RL, Hagestad EL, Lown B. Delayed myocardial ischemia induced by anger. Circulation 1987;75:249.

    Article  PubMed  CAS  Google Scholar 

  56. Verrier RL, Kirby DA, Papageorgiou. Plasma catecholamines and anger-induced delayed myocardial ischemia. Circulation 1988;78:ll-555.(abstract).

    Google Scholar 

  57. Hagestad EL, Verrier RL. Delayed myocardial ischemia following the cessation of sympathetic stimulation. Am Heart J 1988;115:45.

    Article  PubMed  CAS  Google Scholar 

  58. Brezinski DA, Tofler GH, Muller JE, et al. Morning increase in platelet aggregability. Association with assumption of the upright posture. Circulation 1988;78:35.

    Article  PubMed  CAS  Google Scholar 

  59. Nesto RW, Phillips RT, Kett KG, et al. Effect of nifedipine on total ischemic activity and circadian distribution of myocardial ischemic episodes in angina pectoris. Am J Cardiol 1991;67:128.

    Article  PubMed  CAS  Google Scholar 

  60. Peters RW, Muller JE, Goldstein S, et al. Propranolol and the morning increase in the frequency of sudden cardiac death (BHAT Study). Am J Cardiol 1989;63:1518.

    Article  PubMed  CAS  Google Scholar 

  61. Willich SN, Linderer T, Wegscheider K, et al. Increased morning incidence of myocardial infarction in the ISAM study: absence with prior beta-adrenergic blockade. Circulation 1989;80:853.

    Article  PubMed  CAS  Google Scholar 

  62. Penaz J, Roukenz J, van der Waal HJ. Spectral analysis of some spontaneous rhythms in the circulation. In Drischel H and Tiedt N ed. Biokybernetik, Bd I, Karl Marx Univ., Leipzig: 1968;233.

    Google Scholar 

  63. Hyndman BW, Kitney Rl, Sayers B McA. Spontaneous rhythms in physiological control systems. Nature 1971;233:339.

    Article  PubMed  CAS  Google Scholar 

  64. Sayers B McA: Analysis of heart rate variability. Ergonomics 1973;16:17.

    Article  PubMed  CAS  Google Scholar 

  65. Akselrod S, Gordon D, Ubel FA, et al. Power spectrum analysis of heart rate fluctuation: A quantitative probe of beat-to-beat cardiovascular control. Science 1981;213:220.

    Article  PubMed  CAS  Google Scholar 

  66. Akselrod S, Gordon D, Madwed JB, et al. Hemodynamic regulation: Investigation by spectral analysis. Am J Physiol 1985;249:H867.

    PubMed  CAS  Google Scholar 

  67. Guth BD, Heusch G, Seitelberger R, Ross J Jr. Mechanism of beneficial effect of ß- adrenergic blockade on exercise-induced myocardial ischemia in conscious dogs. Circ Res 1987,60:738.

    Article  PubMed  CAS  Google Scholar 

  68. Pagani M, Mazzuero G, Ferrari A, et al. Sympathovagal interaction during mental stress. A study using spectral analysis of heart rate variability in healthy control subjects and patients with a prior myocardial infarction. Circulation 1991;83:ll–43.

    Google Scholar 

  69. Hayano J, Sakakibara Y, Yamada M, et al. Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity. Circulation 1990;81:1217.

    Article  PubMed  CAS  Google Scholar 

  70. Bernardi L, Lumina C, Ferrari MR, et al: Relationship between fluctuations in heart rate and asymptomatic noctural ischemia. Int J Cardiol 1988;20:39.

    Article  PubMed  CAS  Google Scholar 

  71. Malliani A, Lombardi F, Pagani M, Cerutti S. Clinical exploration of the autonomic nervous system by means of electrocardiographic. Ann NY Acad Sci 1990;601:234.

    Article  PubMed  CAS  Google Scholar 

  72. Rimoldi O, Pierini S, Ferrari A, et al. Analysis of short-term oscillations of RR and arterial pressure in conscious dogs. Am J Physiol 1990;258:H967.

    PubMed  CAS  Google Scholar 

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Authors
  1. J. Brouwer MD
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  2. W. H. van Gilst MD
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  3. K. I. Lie MD
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Editors and Affiliations

  1. Department of Clinical Pharmacology, University Hospital Groningen, Groningen, The Netherlands

    W. H. van Gilst

  2. Department of Cardiology Thorax-Center, University Hospital Groningen, Groningen, The Netherlands

    K. I. Lie

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© 1993 Springer Science+Business Media Dordrecht

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Brouwer, J., van Gilst, W.H., Lie, K.I. (1993). Neurohumoral Regulation in Silent Myocardial Ischemia. In: van Gilst, W.H., Lie, K.I. (eds) Neurohumoral Regulation of Coronary Flow. Developments in Cardiovascular Medicine, vol 150. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-1900-9_7

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  • DOI: https://doi.org/10.1007/978-94-011-1900-9_7

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-4839-2

  • Online ISBN: 978-94-011-1900-9

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