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February 1, 1979HeartOpen Access

Electrocardiographic changes resembling myocardial ischaemia in asymptomatic men with normal coronary arteriograms.

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Why the study?

How do physiological and pharmacological maneuvers affect ischemic-appearing ECG changes in asymptomatic men with normal coronary arteries?

Population

20 asymptomatic men aged 18 to 55 with T wave and ST segment abnormalities resembling myocardial ischemia…

Design

Case_series

Authors

PTPeter TaggartUniversity College LondonMCMalcolm CarruthersHudson InstituteSJS P JosephUniversity of Lahore

Discussion

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Overview

May support catecholamine hypersensitivity in Type 1 ECG changes; hypothesis-generating and should not yet change practice.

Key Points

  • To determine the mechanism and clinical significance of electrocardiographic T-wave and ST-segment changes resembling myocardial ischaemia in asymptomatic men.
  • Evaluated 20 asymptomatic men (aged 18–55) with ischaemic-appearing ECG patterns using coronary arteriography, left ventricular angiography, echocardiography, and treadmill exercise testing.
  • Assessed ECG responses to postural shifts, overnight rest, beta-blockade (oxprenolol), and intravenous infusions of adrenaline and noradrenaline alongside plasma catecholamine measurements.
  • Coronary arteriograms revealed unobstructed vessels in 19 of 20 men and an isolated 50% left anterior descending artery lesion in 1, with preserved or elevated ejection fractions across the cohort.
  • Three ECG patterns emerged: Type 1 changes normalized with rest or beta-blockade and were reproduced by adrenaline; Type 2 deep T-wave inversions normalized with adrenaline; Type 3 ST depression remained unaffected.
  • Maximal treadmill exercise tests were positive in 6 of 20 subjects at baseline, but all 20 tests became negative following oxprenolol administration.

Structured PICO

How do physiological and pharmacological maneuvers affect ischemic-appearing ECG changes in asymptomatic men with normal coronary arteries?

P
Population
20 asymptomatic men aged 18 to 55 with T wave and ST segment abnormalities resembling myocardial ischemia and normal coronary arteriograms (except one with a 50% LAD lesion).
I
Intervention
Physiological and pharmacological maneuvers including beta-blockade (oxprenolol), overnight rest, standing position, maximal treadmill exercise, and intravenous adrenaline/noradrenaline infusion.
O
Outcome
Electrocardiographic changes (T wave and ST segment patterns)surrogate

Ischemic-appearing ECG abnormalities in asymptomatic men with normal coronary arteries may be driven by catecholamine hypersensitivity and can be modulated by beta-blockade.

Cite This Study

Taggart et al. (1979) studied this question.

synapsesocial.com/papers/6a70f6c835aa2c282ce24a96https://doi.org/10.1136/hrt.41.2.214
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