Does age and autonomic dysfunction affect the anginal perceptual threshold in patients with ischemic heart disease?
Elderly patients exhibit a delayed perception of angina during myocardial ischemia, which appears to be strongly associated with underlying autonomic dysfunction.
OBJECTIVE: To assess the perception of angina in the elderly and its relationship to autonomic function. DESIGN: Prospective cohort study of patients with exertional ischemia. SETTING: Medical, geriatric and cardiac outpatient clinics in two centers. PARTICIPANTS: All subjects had ischemic heart disease as evidenced by positive treadmill stress tests and, in some, diagnostic angiography and/or documented Q wave infarction. In the first study (I), 37 older patients (range 70-82 years) and 39 younger patients (range 42-59 years) were studied. In a subsequent study (II), a further 49 patients were divided into 2 groups: those with good perception of angina (Anginal Perception Threshold 30 seconds) was analyzed separately, there was a significant correlation between APT prolongation and impaired valsalva response (r = -0.4; P < 0.005). In study II, 21 of 23 patients (91.3%) with positive exercise test but with no angina (group B) had at least one abnormal autonomic function test compared with 5 of 26 (19%) patients with good anginal perception (group A). Of note, group A was significantly younger than group B 60 (53-63) years vs 66 (62-70 years, P < 0.001. CONCLUSION: Elevation of APT in the elderly suggests that warning of critical myocardial ischemia is delayed. Autonomic dysfunction may be one of the underlying mechanisms.
Ambepitiya et al. (Fri,) studied this question.