Heart 1998;80:489-492 ( November )
Triggers of daily life ischaemia
The Department of
Cardiology, Concord Repatriation General Hospital, and the Hallstrom
Institute of Cardiology, Royal Prince Alfred Hospital, University of
Sydney, Sydney, Australia
Correspondence to: Professor Ben Freedman, Department of Cardiology, Concord Repatriation General Hospital, Hospital Road, Concord, 2139, Australia. email: ben{at}card.crg.cs.nsw.gov.au
Accepted for publication 2 July 1998
Objective
To determine the usual triggers of
silent and symptomatic ischaemia.
DesignPatients wore an ambulatory recorder
for 48 hours. The device emitted a tone on detection of ischaemia and
patients noted activities, feelings, and symptoms so that ischaemia
could be attributed to one of four triggers: physical stress, mental
stress, combined physical/mental stress, or no stressor.
SettingHome environment.
PatientsPatients (n = 38) with stable
coronary disease, positive exercise electrocardiography, and ischaemic
episodes on ambulatory electrocardiography.
Main outcome measureMatching ischaemic
episodes with perceived triggers.
ResultsAltogether 257 ischaemic episodes
(53% silent) were documented. Triggers were: physical stress, 56%;
mental stress, 5%; combined physical/mental stress, 8%; no
identifiable trigger, 31%. Episodes associated with mental or no
stress were more often silent (69% and 75%, respectively) than those
associated with physical stress (45%, p < 0.01), while combined
physical/mental stress episodes were usually symptomatic (10% silent,
p < 0.01 v other stressors). Although physical stress
was less commonly a trigger of silent ischaemia than angina (47%
v 65%, p < 0.01), it was still the predominant trigger
of silent ischaemia. There was no identifiable trigger in 45% of
silent and only 17% of anginal episodes (p < 0.01). Only nine
silent episodes involved mental stress alone as a trigger.
ConclusionsDaily life ischaemia is usually
triggered by physical activity. Mental stress alone is an uncommon
trigger of either silent or symptomatic ischaemia, while combined
physical/mental stress is a significant but minor trigger of angina.
Patients can identify a trigger in 83% of anginal episodes, compared
with only half of silent ischaemic episodes.
© 1998 by Heart
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