| Onset of acute myocardial infarction during sleep. | |
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MedLine Citation:
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PMID: 12018882 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Analysis of the chronology of acute cardiovascular events may provide important pathophysiologic information. There is a circadian pattern in the onset of acute myocardial infarction (AMI) with a mid-morning peak, ascribed to the catecholamine surge that accompanies awakening and assuming the upright posture. However, in up to 27% of patients the onset of AMI occurs during sleep (without apparent precipitating factors). The reasons for this finding are unknown. HYPOTHESIS: The aim of the study was to determine why the onset of symptoms of AMI occurs during sleep in some individuals rather than being precipitated by known trigger factors such as physical exertion. METHODS: Using the database from a large multicenter clinical trial, patients were grouped according to whether or not they were awakened from sleep by the symptoms of AMI. RESULTS: In all, 870 of 3,309 patients (26%) were awakened by AMI. In general, these patients were older and sicker, with poorer left ventricular function, lower quality of life indices, more frequent heart failure, lower ejection fractions, higher incidence of angina, and a greater frequency of atrial arrhythmias. On multivariate analysis, only low ejection fraction and older age were independently associated with awakening by the symptoms of AMI. CONCLUSIONS: Patients who are older and sicker are more likely to be awakened from sleep by the onset of symptoms of AMI. Although the reasons are unknown, we speculate that these individuals are less active and therefore less vulnerable to established trigger factors such as vigorous physical exertion. |
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Authors:
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Robert W Peters; Robert G Zoble; Marla M Brooks |
Publication Detail:
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Type: Journal Article; Multicenter Study |
Journal Detail:
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Title: Clinical cardiology Volume: 25 ISSN: 0160-9289 ISO Abbreviation: Clin Cardiol Publication Date: 2002 May |
Date Detail:
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Created Date: 2002-05-20 Completed Date: 2002-12-09 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7903272 Medline TA: Clin Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 237-41 Citation Subset: IM |
Affiliation:
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Department of Medicine, Veterans Affairs Medical Center, Baltimore, Maryland 21201, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Analysis of Variance Circadian Rhythm* Female Humans Male Middle Aged Myocardial Infarction / epidemiology, physiopathology* Randomized Controlled Trials as Topic Regression Analysis Risk Factors Sleep* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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