TY - JOUR
T1 - Circadian variation in variant angina
AU - Waters, David D.
AU - Miller, Donald D
AU - Bouchard, Alain
AU - Bosch, Xavier
AU - Theroux, Pierre
N1 - Funding Information:
From the Department of Medicine, Montreal Heart Institute and the University of Montreal Medical School, Montreal, Quebec, Canada. This study was supported in part by grants from the Alcan Company, the J.-Louis LBvesque Foundation, and the Montreal Heart Institute Research Fund, Montreal, Quebec, Canada. Manuscript received January 9,1984; revised manuscript received March 2, 1984, accepted March 5, 1984. Address for reprints: David D. Waters, MD, Montreal Heart Institute, 5000 East, Belanger Street, Montreal. Quebec, Hlf lC8, Canada.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 1984/7/1
Y1 - 1984/7/1
N2 - Thirteen hospitalized patients with variant angina were studied to assess circadian variation in disease activity. Over 48 hours, all angina attacks were noted, a continuous Holter electrocardiogram was recorded and 2 ergonovine tests were performed 12 hours apart, 1 at 4 am and the other at 4 pm. Only 2 patients gave a clearcut history of more frequent nocturnal or early morning attacks. During the study period, 1.8 ± 1.6 am and 0.62 ± 1.2 pm angina episodes per patient were reported (p < 0.02), but a circadian pattern was apparent in only 4 patients. However, Holter analysis revealed 5.3 ± 13.8 am and 2.6 ± 8.5 pm episodes of ST elevation per patient (p < 0.05) and 8.1 ± 13.9 am and 3.2 ± 8.5 pm episodes of ST elevation, ST depression or T-wave pseudonormalization (p < 0.01). Ten of 11 patients with Holter abnormalities had more frequent am than pm attacks (p < 0.01). ST elevation developed during all 13 of the 4-AM and 12 of 13 of the 4-PM ergonovine tests. In 10 cases the ergonovine threshold at which the attack occurred was lower in the morning, in no case was it lower in the afternoon, and in 3 patients the morning and afternoon doses were identical (p < 0.01). Thus, circadian variation in disease activity both for spontaneous and provoked attacks is present in most patients with variant angina, even though it is often not clinically apparent.
AB - Thirteen hospitalized patients with variant angina were studied to assess circadian variation in disease activity. Over 48 hours, all angina attacks were noted, a continuous Holter electrocardiogram was recorded and 2 ergonovine tests were performed 12 hours apart, 1 at 4 am and the other at 4 pm. Only 2 patients gave a clearcut history of more frequent nocturnal or early morning attacks. During the study period, 1.8 ± 1.6 am and 0.62 ± 1.2 pm angina episodes per patient were reported (p < 0.02), but a circadian pattern was apparent in only 4 patients. However, Holter analysis revealed 5.3 ± 13.8 am and 2.6 ± 8.5 pm episodes of ST elevation per patient (p < 0.05) and 8.1 ± 13.9 am and 3.2 ± 8.5 pm episodes of ST elevation, ST depression or T-wave pseudonormalization (p < 0.01). Ten of 11 patients with Holter abnormalities had more frequent am than pm attacks (p < 0.01). ST elevation developed during all 13 of the 4-AM and 12 of 13 of the 4-PM ergonovine tests. In 10 cases the ergonovine threshold at which the attack occurred was lower in the morning, in no case was it lower in the afternoon, and in 3 patients the morning and afternoon doses were identical (p < 0.01). Thus, circadian variation in disease activity both for spontaneous and provoked attacks is present in most patients with variant angina, even though it is often not clinically apparent.
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U2 - 10.1016/0002-9149(84)90304-7
DO - 10.1016/0002-9149(84)90304-7
M3 - Article
C2 - 6741840
AN - SCOPUS:0021266862
SN - 0002-9149
VL - 54
SP - 61
EP - 64
JO - The American Journal of Cardiology
JF - The American Journal of Cardiology
IS - 1
ER -