| Circadian variation of ambulatory myocardial ischemia. Triggering by daily activities and evidence for an endogenous circadian component. | |
| | |
MedLine Citation:
|
PMID: 8641025 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: The morning peak in myocardial ischemia has been related to diurnal variations in physical and mental activities and to postural changes upon awakening. This study assesses (1) the effects of exogenous activity triggers at different times of the day and (2) the contribution of an endogenous (ie, activity- and posture-independent) circadian vulnerability for ambulatory ischemia. METHODS and RESULTS: Sixty-three stable coronary artery disease patients underwent ambulatory ECG monitoring and completed a structured diary assessing physical and mental activities. During 2519 hours of observation, a morning increase in ischemia coincided with increases in physical and mental activities, and an evening decrease in ischemia coincided with a decline in activities. During the morning, ischemic versus ischemia-free periods were more likely to occur with high levels of physical activity (P < .001). High physical activity triggered ischemia to a lesser but still significant extent (P < .05) in the afternoon but not in the evening (P = NS). High levels of mental activity triggered ischemia significantly during the morning (P < .04) and evening (P < .04) but not in the afternoon. When a residualized score procedure was used to correct ischemic time for each patient's simultaneously measured activities, for hourly heart rates, or for activity-related heart rate fluctuations, the circadian variation in ischemia was still observed (P < .001), with a peak at 6 AM. A significant increase in ischemia occurred immediately after awakening (P < .05), but activity-adjusted increases in morning ischemia persisted (P < .05) for 2 hours after awakening. CONCLUSIONS: Exogenous factors (physical and mental activities) are most potent as triggers of ischemia during the morning hours, and the postural change after awakening contributes to the morning increase in ischemia. There is also evidence for an endogenous, activity-independent circadian influence on ischemic susceptibility that is independent of exogenous factors and that sustains the increase in ischemia upon awakening. |
| | |
Authors:
|
D S Krantz; W J Kop; F H Gabbay; A Rozanski; M Barnard; J Klein; Y Pardo; J S Gottdiener |
Related Documents
:
|
2471895 - Ischemia-induced conduction delay and ventricular arrhythmias: comparative electropharm... 21712275 - Sustained ventricular tachycardia in renal cell carcinoma metastatic to anterior-apical... 3261305 - Comparison of coronary artery bypass surgery and medical therapy in patients with exerc... 3751725 - Ultrastructure of the human myocardium after intermittent ischemia compared to cardiopl... 9187505 - Augmented release of brain natriuretic peptide during reperfusion of the human heart af... 2709745 - Progressive dilated cardiomyopathy in a patient with longstanding and complete predniso... |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
|
Title: Circulation Volume: 93 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1996 Apr |
Date Detail:
|
Created Date: 1996-07-17 Completed Date: 1996-07-17 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1364-71 Citation Subset: AIM; IM |
Affiliation:
|
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA. krantz@usuhsb.usuhs.mil |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Activities of Daily Living Aged Circadian Rhythm* Convalescence Electrocardiography, Ambulatory Female Humans Male Middle Aged Motor Activity / physiology* Myocardial Infarction / epidemiology*, etiology, physiopathology Myocardial Ischemia / complications, physiopathology Records as Topic Wakefulness / physiology |
| Grant Support | |
ID/Acronym/Agency:
|
HL-47337/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis i...
Next Document: Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged m...